Abstract
Aim. Evaluation of trimetazidine influence on the parameters of filtration and tubulo-interstinal function of kidneys in angina patients of II-III functional class (FC) and stable chronic heart failure (CHF) of II-III FC with chronic kidney disease (CKD) stage 3. Material and methods. Totally, 288 stable angina (II-III FC) patients included, among them a cohort selected of 162 (56,3%) CHF II-III FC. In 62 (38,3%) CKD of stage 3 was diagnosed. All CHF and stage 3 CKD patients were randomized to equal 2 groups depending on the kind of treatment. First group patients, together with standard CHF and coronary heart disease (CHD) management, were taking trimetazidine (Preductal МR®, Servier, France) 35 mg in the morning, and the second group patients did not receive trimetazidine. Treatment duration lasted 6 months. For renal function assessment, glomerular filtration rate (GFR) was implemented (CKD-EPIcre), calculated via serum creatinine and cystatin C in the blood (CKD-EPIcys), albumincreatinine ratio in single urine portion (UACR), molecules of tubules damage (KIM-1) in urea, tissue inhibitor of matrix proteases type 1 in the blood (ТIMP-1). Results. Introduction of trimetazidine to the standard therapy of CHD with CHF and CKD stage 3 makes it to not only improve clinical course of the disease, but increases exercise tolerance and demonstrates regression of disorder of kidney function by the dynamics of cystatin C (p=0,005), GFR increase, calculated by cystatin С (p=0,012), decrease of UACR (p=0,002), KIM-1 (p<0,001), restores positive collagenolysis in renal interstitium by dynamics of TIMP-1 decline (p<0,001). Conclusion. Trimetazidine shows nephroprotective effect if added to the treatment of CHD and CHF patients comorbid with CKD stage 3. The effect is characterized by improved filtration function, decrease of albumin secretion with urine, decrease of tubular disorder by suppression of collagen formation in renal interstitium.
Highlights
ДД ЛЖ — диастолическая функция левого желудочка, ишемической болезнью сердца (ИБС) — ишемическая болезнь почек, СКФ — скорость клубочковой фильтрации, функционального класса (ФК) — функциональный класс, фракции выброса левого желудочка (ФВ ЛЖ) — фракция выброса левого желудочка, хронической болезнью почек (ХБП) — хроническая болезнь почек, хронической сердечной недостаточности (ХСН) — хроническая сердечная недостаточность, ЭКГ — элект рокардиография, ЭхоКГ — эхокардиография, KIM-1 — молекулы повреждения канальцев почек 1 типа, NT-proBNP — N-терминальный фрагмент натрийуретического пептида, ТIMP-1 — тканевый ингибитор матриксных протеиназ 1 типа, UACR — соотношение альбумина к креатинину мочи в разовой порции
All chronic heart failure (CHF) and stage 3 chronic kidney disease (CKD) patients were randomized to equal 2 groups depending on the kind of treatment
Trimetazidine shows nephroprotective effect if added to the treatment of coronary heart disease (CHD) and CHF patients comorbid with CKD stage 3
Summary
ДД ЛЖ — диастолическая функция левого желудочка, ИБС — ишемическая болезнь почек, СКФ — скорость клубочковой фильтрации, ФК — функциональный класс, ФВ ЛЖ — фракция выброса левого желудочка, ХБП — хроническая болезнь почек, ХСН — хроническая сердечная недостаточность, ЭКГ — элект рокардиография, ЭхоКГ — эхокардиография, KIM-1 — молекулы повреждения канальцев почек 1 типа, NT-proBNP — N-терминальный фрагмент натрийуретического пептида, ТIMP-1 — тканевый ингибитор матриксных протеиназ 1 типа, UACR — соотношение альбумина к креатинину мочи в разовой порции. Целью нашего исследования явилась оценка влияния триметазидина на показатели фильтрационной и тубулоинтерстициальной функций почек у больных стенокардией II-III ФК на фоне стабильной ХСН IIIII ФК в сочетании с ХБП 3 стадии.
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