METABOLIC FACTORS OF CARDIOVASCULAR RISK IN PATIENTS WITH DIABETIC NEPHROPATHY WHO UNDERGO PROGRAMMED HEMODYALISIS

Abstract

At the present stage, it is important to have a comprehensive assessment of factors that form a very high cardiovascular risk, in patients with chronic kidney disease of the VD stage (CKD VD) of diabetic origin.

The aim of the study – to determine the clinical and metabolic factors associated with diabetic nephropathy (DN) in patients who undergo chronic hemodialysis (HD), and to find out in these conditions the cardiovascular features of impaired mineral and lipid metabolism.

Materials and methods. The study included 121 patients (71 men, age (53.2±1.1) years, duration of HD, (52.2±4.8) months), who were treated by the programmed HD. Patients with chronic glomerulonephritis predominated (34.7 %). Depending on the presence or absence of the second type of diabetes, all subjects were divided into two groups: group 1 – without DN (n = 86); 2 – with DN (n = 35). The complex of clinical and laboratory examinations provided estimation of anthropometric, gender characteristics, indicators of blood pressure, research of lipid spectrum, phosphate-calcium metabolism, analysis of the frequency of cardiovascular complications.

Results and discussion. It was established that patients with DN were older (р<0.001), had shorter duration of HD (p=0.040), predialysis stage of CKD (p=0.011); they were significantly more often diagnosed with arterial hypertension (97.1 %), coronary heart disease (77.1 %), heart failure (77.1 %) and arrhythmia (48.6 %). Concentration of high density lipoprotein cholesterol (HDL cholesterol) in patients of the group 2 was lower (p<0.001) and the content of triglycerides (TG) – higher (p=0.036) than in patients of the group 1, respectively. For the first time at CKD VD was determined the serum decrease of magnesium content (Mg) in patients with DN ((0.86±0.02) vs. (1.01±0.02) mmol/l, p<0.001) compared with those without DN, while in the group 2, the Mg and HDL cholesterol indices (Rs = 0.39, p = 0.022), as well as Mg and TG (Rs = -0.47, p = 0.005) closely correlated.

Conclusions. Violation of lipid metabolism, mineral metabolism imbalance with the development of Mg deficiency, hypertriglyceridemia and decreased HDL cholesterol are obviously one of the factors of progression of atherosclerosis, cardiovascular remodeling and high frequency of cardiovascular complications in patients with DN in chronic HD.