Traditional cardiovascular risk factors and glomerular filtration rate in patients with rheumatoid arthritis

Abstract

Abstract The leading cause of premature death in rheumatoid arthritis (RA) is cardiovascular complications associated with vascular atherosclerosis. Even a slight decrease in glomerular filtration rate (GFR) is an important independent risk factor for cardiovascular complications. The purpose of the study: to determine GFR in patients with RA, to identify the relationship between GFR and traditional risk factors for the development of cardiovascular complications. Methods The study included 58 patients with RA aged 21 to 60 years, who do not have concomitant kidney diseases, arterial hypertension (AH) of stage III, and diseases accompanied by the development of secondary nephropathy. GFR was calculated using the CKD-EPI formula. All patients were evaluated for traditional cardiovascular risk factors: hypertension, dyslipidemia, a complicated hereditary history of early development of cardiovascular diseases, overweight, and smoking. The European SCORE scale and the Reynolds Risk Score (RRS) predictive scale in the EULAR modification were used to assess the total risk of cardiovascular complications. Results Women predominated among the patients – 61 (86.6%). The mean age of patients is 45 years. Seropositive patients with rheumatoid factor prevailed, with moderate and high activity of the process, III x-ray stage according to Steinbroker. In 36 (62%) patients, GFR was in the range from 60 to 89 ml/min/1.73m2, in 38% of patients-more than 90 ml/min/1,73m2. The average GFR in patients with RA was 88.43±16.13 ml/min/1.73m2, in the comparison group-83.54±15.22 ml/min/1.73m2 (p=0.063). Arterial hypertension was diagnosed in 40 (68.9%) patients with RA: 70.2% of women and 55.3% of men. The level of total cholesterol in patients with RA is significantly higher than in the comparison group (p<0.001), even in patients younger than 40 years, the level of total cholesterol is higher than in those without arthritis (5±1.15 and 4.14±0.21 mmol/l, p=0.027). The average value of the SCORE scale in RA patients and in the comparison group is generally comparable, and when compared by age periods. In patients younger than 40 years who suffer from hypertension, GFR is lower than in patients of the same age, but without hypertension: 86 [79; 101.5] and 104.5 [101; 112] ml/min/1.73m2, respectively, p=0.043. Relationships between GFR and traditional cardiovascular risk factors were identified: body mass index (r=−0.414; p<0.001), total cholesterol levels (r=−0.402; p<0.001), low-density lipoproteins (r=−0.331; p=0.013), triglycerides (r=−0.283, p=0.028), systolic BP (r=−0.257; p=0.027), diastolic BP (r=−0.255; p=0.029) at the time of the study, the value of the Score scale (r=−0.529; p<0.001) and RRS (r=−0.341; p=0.031). Conclusion Most patients with rheumatoid arthritis showed a decrease in glomerular filtration rate, and GFR is associated with traditional risk factors for cardiovascular events. Funding Acknowledgement Type of funding source: None