METABOLIC FACTORS OF CARDIOVASCULAR RISK IN PATIENTS WITH DIABETIC NEPHROPATHY WHO UNDERGO PROGRAMMED HEMODYALISIS
DOI:
https://doi.org/10.11603/2415-8798.2018.4.9813Keywords:
diabetic nephropathy, hemodialysis, cardiovascular complications, risk factors, magnesium deficiency, dyslipidemiaAbstract
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.
References
Bazyluk, A., Malyszko, J., & Zbroch, E. (2018). Cardiovascular risk in chronic kidney disease: what is new in the pathogenesis and treatment? Postgrad Med, 130, 5, 461-469.
Zaoui, P., Hannedouche, T., & Combe, C. (2017). Cardiovascular protection of diabetic patient with chronic renal disease and particular case of end-stage renal disease in elderly patients. Nephrol Ther, 13, 6S, 16-24.
Chen, H., Wang, D.G., Yuan, L., Liu, G.L., He, H.J., Wang, J., … & Hao, L. (2016). Clinical characteristics of patients with diabetic nephropathy on maintenance hemodialysis: a multicenter cross-sectional survey in anhui province, eastern China. Chin Med J, 129, 11, 1291-1297.
Kidney Disease: Improving Global Outcomes (KDIGO) CKD-MBD Work Group. (2017). KDIGO clinical practice guideline for the diagnosis, evaluation, prevention, and treatment of chronic kidney disease – mineral and bone disorder (CKD-MBD). Kidney Int (Suppl), 7, 1-59.
Kidney Disease: Improving Global Outcomes (KDIGO) Lipid Work Group. (2013). KDIGO сlinical practice guideline for lipid management in chronic kidney disease. Kidney Int (Suppl), 3, 259-305.
Litovkinа, Z.I., Susla, O.B., & Daniliv, S.V. (2017). Osoblyvosti patohenezu remodeliuvannia sertsia u khvorykh iz diabetychnoiu khvoroboiu nyrok [Features of pathogenesis of remodeling of heart in patients with diabetic kidney disease]. Proceedings of the scientific conference : XVI-ye chteniya im. V.V. Podvysotskogo : byulleten materialov nauchnoy konferentsii – V.V. Podvysotsky XVII-th reading. (pp. 196-198). Odessa: Ukrainian research institute of medical transport [in Ukrainian].
Hirano, T. (2014). Abnormal lipoprotein metabolism in diabetic nephropathy. Clin Exp Nephrol, 18, 2, 206-209.
Topchiy, I.I., Denysenko, V.P., Kiriyenko, O.M., Semenovykh, P.S., Yakymenko, Yu.S., Maziy, V.V., & Shchenyavska, O.M. (2017). Zviazok stanu miokardu z porushenniamy fosforno-kaltsiievoho obminu u khvorykh na diabetychnu nefropatiiu [Relationship of the state of myocardium with disturbances of phosphorous-calcium metabolism in patients with diabetic nephropathy]. Ukrayinskyi zhurnal nefrolohii ta dializu – Ukrainian Journal of Nephrology and Dialysis, 2, 27-32 [in Ukrainian].
Gozhenko, A.I., Kuznetsova, A.S., Kuznetsova, Ye.S., Byts, T.N., & Susla, A.B. (2017). Endotelialnaya disfunktsiya v patogeneze oslozhneniy sakharnogo diabeta. Soobshcheniye I. Endotelialnaya disfunktsiya: etiologiya, patogenez i metody diagnostiki [Endothelial dysfunction in the pathogenesis of diabetes mellitus. Report I. Endothelial dysfunction: etiology, pathogenesis and diagnostic methods]. Endokrynolohiya – Endocrinology, 22, 2, 171-181 [in Russian].
Nasri, H., & Kheiri, S. (2008). Effects of diabetes mellitus, age, and duration of dialysis on parathormone in chronic hemodialysis patients. Saudi J Kidney Dis Transpl, 19, 4, 608-613.
Floege, J. (2015). Magnesium in CKD: more than a calcification inhibitor? J Nephrol, 15, 269-277.
Sakaguchi, Y., Fujii, N., Shoji, T., Hayashi, T., Rakugi, H., & Isaka, Y. (2014). Hypomagnesemia is significant predictor of cardiovascular and non-cardiovascular mortality in patients undergoing hemodialysis. Kidney Int, 85, 174-181.
Hamono, N., Komaba, H., & Fukagawa, M. (2017). Magnesium as a new player in CKD: too little is as bad as too much? Kidney Int, 92, 1034-1036.
Tzanakis, I.P., Stamataki, E.E., Papadaki, A.N., Giannakis, N., Damianakis, N.E., & Oreopoulos, D.G. (2014). Magnesium retards the progress of the arterial calcifications in hemodialysis patients: a pilot study. Int Urol Nephrol, 46, 11, 2199-2205.
Peev, V., Nayer, A., & Contreas, G. (2014). Dyslipidemia, malnutrition, inflammation, cardiovascular disease and mortality in chronic kidney disease. Curr Opin Lipidol, 25, 1, 54-60.
Glowinska, I., Grochowski, J., & Malyszko, J. (2008). Cardiovascular complications in patients with diabetic nephropathy receiving pharmacological versus renal replacement therapy. Pol Arch Med Wewn, 118, 7-8, 404-412.
Chaykovska, M.I., & Martynyuk, L.P. (2018). Zvyazok faktora rostu fibroblastiv 23 ta lipidnoho obminu u khvorykh na khronichnu khvorobu nyrok [The relationship of the growth factor of firoblast 23 and lipid exchange in patients with chronic kidney disease]. Ukrayinskyi zhurnal nefrolohii ta dializu – Ukrainian Journal of Nephrology and Dialysis, 2, 34-40 [in Ukrainian].
Korotkyy, D.V., Herasymchuk, R.P., Makeeva, T.Y., Zavarytskaya, O.P., & Zemchenkov, A.Yu. (2011). Vtorichnyy giperparatireoz i mitralno-aortalnyy kaltsinoz na preddializnykh stadiyakh KHBP i pri zamestitelnoy pochechnoy terapii [Secondary hyperparathyroidism and mitral-aortic calcification in the predialysis stages of CKD and renal replacement therapy]. Nefrologiya i dializ – Nephrology and dialysis, 13, 2, 89-95 [in Russian].
Guh, J.Y., Chen, H.C., Chuang, H.Y., Huang, S.C., Chien, L.C., & Lai, Y.H. (2002). Risk factors and risk for mortality of mild hypoparathyroidism in hemodialysis patients. Am J Kidney Dis, 39, 6, 1245-1254.
Dewitte, K., Dhondt, A., & Giri, M. (2004). Differences in serum ionized and total magnesium values during chronic renal failure between nondiabetic and diabetic patients: a cross-sectional study. Diabetes Care, 27, 10, 2503-2505.
Maier, J.A. (2012). Endothelial cells and magnesium: implications in atherosclerosis. Clin Sci Lond., 122, 9, 397-407.
Sakaguchi, Y., Shoji, T., Hayashi, T., Suzuki, A., Shimizu, M, Mitsumoto, K., … & Tsubakihara, Y. (2012). Hypomagnesemia in type 2 diabetic nephropathy: a novel predictor of end-stage renal disease. Diabetes Care, 35, 7, 1591-1597.
Sacks, F.M., Hermans, M.P., Fioretto, P., Valensi, P., Davis, T., Horton, E., & Carey, V.J. (2014). Association between plasma triglycerides and high-density lipoprotein cholesterol and microvascular kidney disease and retinopathy in type 2 diabetes mellitus: a global case-control study in 13 countries. Circulation, 129, 9, 999-1008.
Bardini, G., Rotella, C.M., & Giannini, S. (2012). Dyslipidemia and diabetes: reciprocal impact of impaired lipid metabolism and beta-cell dysfunction on micro- and macrovascular complications. Rev Diabet Stud, 9, 2-3, 82-93.
Moradi, H., Streja, E., Kashyap, M.L., Vaziri, N.D., Fonarow, G.C., & Kalantar-Zadeh, K. (2014). Elevated high-dencity lipoprotein cholesterol and cardiovascular mortality in maintenance hemodialysis patients. Nephrol Dial Transplant, 29, 1554-1562.
Lima, Mde L., Cruz, T., Rodrigues, L.E., Bomfim, O., Melo, J., Correia, R., & Vicente, E. (2009). Serum and intracellular magnesium deficiency in patients with metabolic syndrome--evidences for its relation to insulin resistance. Diabetes Res Clin Pract, 83, 2, 257-262.
Mortazavi, M., Moeinzadeh, F., Saadatnia, M., Shahidi, S., McGee, J.C., & Minagar, A. (2013). Effect of magnesium supplementation on carotid intima-media thickness and flow-mediated dilatation among hemodialysis patients: a double-blind, randomized, placebo-controlled trial. Eur Neurol, 69, 5, 309-316.
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