Abstract
Aim . To determine the frequency of markers of chronic kidney disease (CKD) in hypertensive patients with high and very high cardiovascular risk, to assess relationship with the renal hemodynamics. Material and methods . We studied 70 patients with medically-controlled hypertension (63,2±8,3 years, 48,6% male, office blood pressure (BP) was 130,5±13,7/78,1±8,5 mm Hg), 40 patients from them as part the Russian multicenter program CHRONOGRAF. Measurement of the office BP, ambulatory BP monitoring were performed. Glomerular filtration rate (GFR) was calculated using the CKD-EPI formula, and albuminuria (AU) was determined as albumin/creatinine (A/Cr) ratio in the morning portion of urine (n=40) or 24-hour urinary albumin excretion (UAE) (n=22). Intrarenal vascular resistance was estimated by renal duplex Doppler ultrasound, the resistive index (RI) levels were calculated. Results . GFR and albuminuria were normal in 68,6% of patients with well-medically-controlled hypertension: achieved levels of office BP, BP-day and BP-night were established. Markers of CKD were detected in 31,4% of patients (GFR 30 mg/g and/or UAE >30 mg/day in 12,9%). RI in the segmental intrarenal arteries was correlated with GFR (Rs=-0,4232, p=0,0005). The levels of renal RI were higher in CKD-patients vs non-CKD-patients and those were the highest in diabetic patients. The impact of the RI values in segmental IRA to the detection of CKD markers was established during the ROC-analysis. Conclusion . The high frequency of markers of CKD (31,4%) was identified even in patients with well-medically-controlled hypertension. The negative correlation was between GFR and RI. There were expressed disturbances of renal hemodynamics in the presence of CKD markers, especially in patients with DM2. The cut-off point RI in segmental IRA to the identification of markers of CKD is 0,725.
Highlights
А/Кр — отношение альбумин/креатинин в разовой утренней порции мочи, артериальной гипертонией (АГ) — артериальная гипертония, АД — артериальное давление, внутрипочечных артерий (ВПА) — внутрипочечная артерия, внутрипочечного сосудистого сопротивления (ВПСС) — внутрипочечное сосудистое сопротивление, гипертонической болезни (ГБ) — гипертоническая болезнь, диастолическим АД (ДАД) — диастолическое артериальное давление, МПА — магистральная почечная артерия, резистивного индекса (РИ) — резистивный индекс, систолическим АД (САД) — систолическое артериальное давление, СД — сахарный диабет, скорости клубочковой фильтрации (СКФ) — скорость клубочковой фильтрации, суточное мониторирование АД (СМАД) — суточное мониторирование артериального давления, СЭА — скорость суточной экскреции альбумина, хронической болезни почек (ХБП) — хроническая болезнь почек, resistive index (RI) — резистивный индекс
The negative correlation was between Glomerular filtration rate (GFR) and RI
С обеих сторон на уровне МПА, сегментарных и дуговых ВПА определяли максимальную систолическую и конечнодиастолическую скорости кровотока, после чего рассчитывали резистивный индекс для каждого из уровней: РИ = (V max — V min)/V max
Summary
The high frequency of markers of CKD (31,4%) was identified even in patients with well-medically-controlled hypertension. The negative correlation was between GFR and RI. There were expressed disturbances of renal hemodynamics in the presence of CKD markers, especially in patients with DM2. The cut-off point RI in segmental IRA to the identification of markers of CKD is 0,725. SRI of Cardiology, Tomsk National Research Medical center of RAS, Tomsk, Russia.
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