Proaterogenic metabolic disorders in patients with chronic kidney disease nondiabetic origin: possibility of statin therapy

Abstract

PURPOSE AND MATERIAL: In order to study the state of coronary arteries, and dynamics of parameters of kidney function, lipid metabolism, levels of glycated hemoglobin (HbA1c), uricemia during administration of atorvastatin in a complex of standard cardioprotective treatment, we examined 54 patients with chronic kidney disease (CKD) of nondiabetic origin. All patients were divided in 2 groups: group I - 31 patients with glomerular filtration rate (GFR) <60 ml/min, who were additionally administered atorvastatin 20 mg/day; group II - 23 patients with glomerular filtration rate (GFR) more or equal 60 ml/min. On day 1 of hospitalization and after 6 months of treatment we determined levels of systolic and diastolic blood pressure (SBP and DBP), pulse pressure (PBP), lipid profile, uric acid levels, HbA1c and GFR (Cockcroft - Gault). Angiography of coronary arteries was also performed. It was found that three of four patients with CKD had coronary stenosis >50% in at least one coronary artery, combined with a substantial elevation of levels of atherogenic lipid fractions, HbA1c and uric acid. Administration of combination atorvastatin with standard treatment of CKD allowed to achieve significant reduction of levels of atherogenic lipid fractions, HbA1c, and uricemia, additional reductions in SBP and PBP by 4-5 mm Hg. Six-months therapy with statin was accompanied by 1.5 fold increase of GFR in patients with initial levels of GFR <60 ml/min. Thus, in patients with nondiabetic CKD statin therapy not only improved lipid metabolism, but also facilitated reduction of HbA1c and uricemia, improved BP control and functional ability of kidneys, especially in individuals with significant coronary artery stenosis.