Нефрологічні аспекти метаболічного синдрому у пацієнтів з хронічною хворобою нирок на перитонеальному діалізі з різними клінічними варіантами ішемічної хвороби серця

Abstract

The purpose of the study was to identify the components of the metabolic syndrome most characteristic of different clinical variants of ischemic heart disease in patients with chronic kidney disease on peritoneal dialysis. Materials and methods. 114 patients took part in the study. The average duration of peritoneal dialysis therapy was 53 months. Clinical variants of ischemic heart disease were determined by angina attacks, by painless myocardial ischemia detected by ECG-load cycle ergometer test, by increasing phenomena of ischemic dilated cardiomyopathy (diastolic dysfunction, calcification and atheromatosis of aorta and heart valves) by echocardiographic study in dynamics and by the previous myocardial infarction episodes. All patients were accordingly divided into 5 clinical groups, one of which was patients with no evidence of coronary heart disease (comparison group). The data were processed using the SPSS 19.0 for Windows statistical software package. Results and discussion. Considering different components of metabolic syndrome: body weight, arterial hypertension, dyslipidemia, the highest body mass index in patients on peritoneal dialysis was found in the group of patients suffering from ischemic dilated cardiomyopathy. High-density lipoproteins were lowest in the group of patients who underwent myocardial infarction. Hypertriglyceridemia was most pronounced in the group of patients with painless myocardial ischaemia. Low-density lipoproteins were highest in the group of patients with stable angina pectoris. Mean arterial pressure was highest in the group of patients with stable angina and in the group of patients with painless myocardial ischaemia. Conclusion. The highest number of patients with metabolic syndrome was found in the groups of patients with non-painful myocardial ischemia and ischemic dilated cardiomyopathy (67% and 51% respectively). In the group of patients with non-painful myocardial ischaemia (high acute coronary risk group), metabolic syndrome was diagnosed by four features: visceral obesity, raised blood sugar, arterial hypertension, raised very low density of lipoproteins and triglycerides. In the group of patients with ICDMP (group of patients with severe diastolic heart failure), metabolic syndrome was diagnosed by three features: visceral obesity, elevated blood sugar and low density lipoproteins. Thus, a vector for further research may be to investigate the effect of complexly corrected components of the metabolic syndrome on the occurrence of acute coronary risks or progression of chronic heart failure in patients with chronic kidney disease on peritoneal dialysis