Cardiovascular and nephrological risk in patients with chronic kidney disease in ambulatory care.
DOI:
https://doi.org/10.26641/2307-0404.2019.3.181874Keywords:
cardiovascular risk, chronic kidney disease, progression, arterial hypertensionAbstract
Patients with chronic kidney disease (CKD) have higher than in general population all-cause and cardiovascular mortality. Arterial hypertension (HTN) is a powerful potentially modifiable risk factor that affects the majority of patients with chronic kidney disease and one of the main causes of end stage renal disease worldwide. Existing tools for assessment of risk of CKD progression do not take into account arterial hypertension. The aim – to investigate the association between cardiovascular and nephrological risk factors in patients with CKD in ambulatory practice. The study was carried out in the Center of Nephrology Care in Mechnikov Dnipropetrovsk Regional Hospital, Dnipro, Ukraine. 278 patients (114 males and 164 women, aged 41 [31;61] years) with CKD (stages 1-3) who were followed-up in ambulatory care, but required diagnosis or treatment revision were enrolled to the study. All patients were examined and followed-up according to local and European standards. Females slightly prevailed in our study, gender distribution varied insufficiently in groups by CKD progression risk. Elevation of risk of CKD progression was accompanied by rise of prevalence of diabetes mellitus, left ventricle hypertrophy, proteinuria and HTN. Risk of CKD progression correlated with age, systolic and diastolic blood pressure, erythrocyte sedimentation rate, total cholesterol, glomerular filtration rate, albumin excretion rate, duration of HTN and body mass index. Rise of cardiovascular risk was accompanied by rise of proportion of patients with high risk of CKD progression. Increase in risk of CKD progression is associated with rise of burden of cardiovascular risk factors. HTN and blood pressure values should be accounted for assessment of risk of CKD progression.
References
Carrero JJ, Grams ME, Sang Y, Gasparini A, Matsushita K, Evans M, et al. Albuminuria changes and subsequent risk of end-stage renal disease and mortality. Kidney Int. 2018;91(1):244-51. doi: https://doi.org/10.1016/j.kint.2016.09.037
Mahmoodi BK, Matsushita K, Woodward M, Blankestijn J, Cirillo M, Ohkubo T, et al. Associations of kidney disease measures with mortality and end-stage renal disease in individuals with and without hypertension: a meta-analysis. The Lancet. 2012;380(9854):1649-61. doi: https://doi.org/10.1053/j.ackd.2014.12.001
Bolignano D, Zoccali C. Non-proteinuric rather than proteinuric renal diseases are the leading cause of end-stage kidney disease. Nephrol Dial Transplant. 2017;32(March 2017):ii194-9. doi: https://doi.org/10.1093/ndt/gfw440
Thompson S, James M, Wiebe N, Hemmelgarn B, Manns B, Klarenbach S, et al. Cause of Death in Patients with Reduced Kidney Function. J Am Soc Nephrol [Internet]. 2015;26(10):2504-11. Available from: http://www.jasn.org/cgi/doi/10.1681/ASN.2014070714. doi: https://doi.org/10.1681/ASN.2014070714
Heerspink HJL, Gansevoort RT, Brenner BM, Cooper ME, Parving HH, Shahinfar S, et al. Comparison of Different Measures of Urinary Protein Excretion for Prediction of Renal Events. J Am Soc Nephrol. 2010;21:1355-60. doi: https://doi.org/10.1681/ASN.2010010063
Mattace-Raso F, Hofman A, Verwoert G, Wittemana J, Wilkinson I, Cockcroft J, et al. Determinants of pulse wave velocity in healthy people and in the presence of cardiovascular risk factors : establishing normal and reference values. Eur Heart J. 2010;185:2338-50. doi: https://doi.org/10.1093/eurheartj/ehq165
Wouters OJ, O’Donoghue DJ, Ritchie J, Kanavos PG, Narva AS. Early chronic kidney disease: Diagnosis, management and models of care. Nature Reviews Nephrology; 2015. doi: https://doi.org/10.1038/nrneph.2015.85
Piepoli MF, Hoes AW, Agewall S, Albus C, Brotons C, Catapano AL, et al. 2016 European Guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J. 2016;37(29):2315-81. doi: https://doi.org/10.1093/eurheartj/ehw106
Firke S. janitor: Simple Tools for Examining and Cleaning Dirty Data. R package version 1.2.0. [software]. 2019. Available from: https://CRAN.R-project.org/package=janitor
Greve SV, Laurent S, Olsen MH. Estimated Pulse Wave Velocity Calculated from Age and Mean Arterial Blood Pressure. Pulse [Internet]. 2016;4(4):175-9. Available from: https://www.karger.com/Article/FullText/453073. doi: https://doi.org/10.1159/000453073
Hlavac, Marek. stargazer: Well-Formatted Regression and Summary Statistics Tables. R package version 5.2.1. [software]. 2018. Available from: https://CRAN.R-project.org/package=stargazer
Amdur RL, Feldman HI, Gupta J, Yang W, Kanetsky P, Shlipak M, et al. Inflammation and Progression of CKD : The CRIC Study. Clin J Am Soc Nephrol. 2016;11(9):1546-56. doi: https://doi.org/10.2215/CJN.13121215
Judd E, Calhoun DA. Management of Hypertension in CKD: Beyond the Guidelines. Advances in Chronic Kidney Disease; 2015. doi: https://doi.org/10.1053/j.ackd.2014.12.001
Eknoyan G, Lameire N, Echardt K, Kasiske B, Wheeler D, Abboud O. KDIGO Clinical Practice Guideline for the Management of Blood Pressure in Chronic Kidney Disease. Kidney Int. 2012;Supp:2(5):337-414. doi: https://doi.org/10.1038/kisup.2012.7
Eknoyan G, Lameire N, Echardt K, Kasiske B, Wheeler D, Abboud O. KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Int Suppl [Internet]. 2013;3(1):1-150. doi: https://doi.org/10.1038/kisup.2012.76
National Institute for Health and Clinical Excellence. Chronic kidney disease in adults: assessment and management. NICE Guidelines; 2014
R Core Team R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria; 2019. Available from: https://www.R-project.org/
Teo BW, Loh PT, Wong WK, Ho PJ, Choi KP, Toh QC, et al. Spot Urine Estimations Are Equivalent to 24-Hour Urine Assessments of Urine Protein Excretion for Predicting Clinical Outcomes. Int J Nephrol.; 2015 (Epub 2015 Jan 8.). doi: https://doi.org/10.1155/2015/156484
Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A, Böhm M, et al. 2013 ESH/ESC guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J. 2013;34(28):2159-219. doi: https://doi.org/10.1093/eurheartj/eht151
Whelton PK, Carey RM, Aronow WS, Ovbiagele B, Casey DE, Smith SC, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults [Internet]. Journal of American College of Cardiology. 2017;283. Available from: http://www.ncbi.nlm.nih.gov/pubmed/29133356. doi: https://doi.org/10.1161/HYP.0000000000000066
Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Hear J. 2018;39(33):3021-104. doi: https://doi.org/10.1093/eurheartj/ehy339
Downloads
How to Cite
Issue
Section
License
Copyright (c) 2019 Medicni perspektivi (Medical perspectives)
This work is licensed under a Creative Commons Attribution 4.0 International License.
Submitting manuscript to the journal "Medicni perspektivi" the author(s) agree with transferring copyright from the author(s) to publisher (including photos, figures, tables, etc.) editor, reproducing materials of the manuscript in the journal, Internet, translation into other languages, export and import of the issue with the author’s article, spreading without limitation of their period of validity both on the territory of Ukraine and other countries. This and other mutual duties of the author and all co-authors separately and editorial board are secured by written agreement by special form to use the article, the sample of which is presented on the site.
Author signs a written agreement and sends it to Editorial Board simultaneously with submission of the manuscript.
