The effect of knee replacement on renal function in patients with hypertension and type 2 diabetes mellitus

Abstract

Objective: to evaluate the effect of knee replacement on kidney function in patients with hypertension and type 2 diabetes mellitus. Materials and methods: at stage 1, 308 people suffering from hypertension (GB), stage III osteoarthritis of the knee joint (OA CS), type 2 diabetes mellitus (DM) were examined. GB occurred in 308 people, DM — in 66 people, and OA CS — in 216 people. Depending on the presence of OA CS, observation and comparison groups were identified. Within each group, subgroups are distinguished by the presence of SD: subgroup 1 (n=170)  — OA CS +GB, subgroup 2 (n=46) — OA CS+GB+SD, subgroup 3 (n=72) — GB, subgroup 4 (n=20) — GB+SD. At stage 2, the dynamics of GFR after total knee arthroplasty (TEP CS) in subgroups 1 and 2 and against the background of AGT therapy in subgroups 3 and 4 were evaluated. Results: at the 1st stage, it was found that the proportion of people with GFR 60 ml/min/1.73 m2 was significantly higher in subgroup 1 (OA CS+GB) compared with subgroup 3 of patients with GB without joint pathology (40.6% vs. 12.5%, p0.01). The presence of DM in patients with GB significantly affected renal filtration function, which is reflected in an increase in serum creatinine levels in subgroup 4 (GB+DM) by 20.02% and a decrease in GFR by 15.35%.Against the background of the performed TEP in the group with GB, 64.06% had a stable GFR value or its increase, and in the subgroup of GB+ DM after TEP, 72.41% of patients had an increase or stable state of renal filtration capacity. At the same time, during the same follow-up period in the comparison group (in patients with GB without comorbid conditions), only 39.13% of cases had stable GFR values, and a decrease in GFR was recorded in 60.87%. At the same time, the dynamics of GFR values manifested itself in an increase of 11.19% in patients of subgroup 5 (TEP CS + GB) and by 12.47% in the group of the described knee joint intervention with a combination of GB and DM. In patients with controlled hypertension, GFR decreased by 6.6%. Conclusion: knee replacement in patients with hypertension and type 2 diabetes mellitus can slow down the rate of GFR reduction.