CARDIOVASCULAR PREDICTORS OF RENAL DYSFUNCTION IN ELDERLY HYPERTENSIVE PATIENTS: PP.30.194

Abstract

Objective: To investigate the incidence and cardiovascular predictors of mild renal dysfunction in elderly patients with essential arterial hypertension (AH). Design and Method: 276 hypertensive patients (108 of those were male) at the mean age of 73.0 ± 7.3 years were examined. The following renal dysfunction indicators were stated: slight plasma creatinine increase 115–133 μmol/l in men or 107–124 μmol/l in women, microalbuminuria (MAU) by urine albumin-creatinine ratio >=2.5 mg/mmol in men or >=3.5 mg/mmol in women and creatinine clearance by Cockroft-Gault formula (CC) <60 ml/min/1.73 m2. The overt renal impairment was diagnosed in patients with plasma creatinine >133 μmol/l in men or >124 μmol/l in women. The 24-h ABPM was carried out. We studied AH risk factors such as serum lipids, smoking, waist circumference and AH target organs (heart and vessels) damage signs: echocardiographic left ventricular mass and ejection fraction (EF), 6-minute walk distance (6MWD), carotid intima-media thickness (IMT), ankle-brachial index, endothelium-dependent brachial artery dilatation test, carotid-femoral pulse wave velocity (PWV). The relations between above-mentioned parameters and renal dysfunction indicators were estimated by multiple logistic regression analysis. Results: Plasma creatinine level averaged 91.4(77–104) μmol/l, CC – 56.0(49–66) ml/min/1.73 m2, urine albumin-creatinine ratio – 0.9(0.2–2.4) mg/mmol. Slight plasma creatinine increase was found in 37 patients (13.4%), MAU – in 52 (18.8%), CC<60 ml/min/1.73 m2 – in 170 (61.6%), renal impairment - in 12 (4.3%). Regression analysis showed that hypercreatininemia was interrelated with male sex and waist circumference (R2=0.13, predictive value of the model is 81.8%). The level of LDL-cholesterol, waist circumference, IMT, systolic blood pressure hypotension load and EF were associated with MAU presence (R2 = 0.34, predictive value 83.0%). Markers of low CC were represented by waist size, PWV and 6MWD (R2 = 0.30, predictive value 68.7%). Conclusions: Elderly hypertensive patients most frequently (61.6%) display a moderate decline of creatinine clearance. The complex of cardiovascular, hemodynamic and metabolic predictors for different variants of hypertensive nephropathy was revealed. Appropriate logistic regression equations were created.