The role of renal anemia and cardiovascular disease in the progression of chronic glomerulonephritis


Cite item

Full Text

Abstract

Aim. To study the rate of chronic glomerulonephritis progression when added by anemia and cardiovascular disease (CVD). Subjects and methods. 231 patients (133 men and 98 women) with predialysis chronic glomerulonephritis (CGN) were examined. The patients’ mean age of was 35.8±11.8 years; the disease duration was 1 to 17 years. The disease onset was the date when urinalysis showed evidence of persistent proteinuria and (or) hematuria. Besides, the time when anemia developed and the clinical and instrumental signs of CVD appeared was taken as the initial reference point; the time when end-stage renal failure was diagnosed was taken to be the endpoint. Red blood cell counts with the inclusion of its indices, hemoglobin concentration, hematocrit values, daily proteinuria values, and glomerular filtration rate were analyzed. The biochemical parameters included the concentrations of electrolytes, creatinine, fibrinogen, iron, cholesterol, total protein and C-reactive protein (CRP). Electrocardiography and echocardiography, bicycle ergometry and 24-hour ECG monitoring were used to detect CVD. Results. The presence of anemia and CVD in patients with predialysis CGN versus those without anemia and CVD was associated with an increase in the concentrations of CRP [36.2 and 12.6%; respectively; (p<0.05)], creatinine [123.0 (83.2—217.0) and 86.5 (72.0—128.5) µmol/L; (p<0.05)] and a decrease in GFR [65.4 (30.8—95.5) and 92.7 (64.5—122.3) ml/min; (p<0.05)]. The 8-year survival of patients with CGN concurrent with CVD was noted to be 58% whereas the renal survival in patients with CGN + CVD + anemia was shorter and the 6-year survival in this case was as high as 52%. Conclusion. Anemia and CVD in patients with CGN serve as additional independent factors for the progression of the underlying disease. The concurrence of CGN, anemia, and CVD substantially reduces the predialysis period.

References

  1. Мухин Н.А. Снижение скорости клубочковой фильтрации общепопуляционный маркер неблагоприятного прогноза. Терапевтический архив. 2007;6:5-10. http://www.mediasphera.ru/journals/terapevt
  2. Eckardt KU, Kim J, Kronenberg F, Aljama P, Anker SD, Canaud B, Molemans B, Stenvinkel P, Schernthaner G, Ireland E, Fouqueray B, Macdougall C. Hemoglobin variability does not predict mortality in European hemodialysis patients. J Am Soc Nephrol. 2010;21:1765-1775. PMCID: PMC3013534. doi: 10.1681/ASN.2009101017.
  3. Eckardt KU, Scherhag A, Macdougall IC, Tsakiris D, Clyne N, Locatelli F, Michael FZ, Burger HU, Drueke TB. Left ventricular geometry predicts cardiovascular outcomes associated with anemia correction in CKD. JAmSoc Nephrol. 2009;20(12):2651-2660. PMCID: PMC2794228. doi: 10.1681/ASN.2009060631.
  4. Мухин Н.А., Моисеев В.С., Кобалава Ж.Д. Моисеев С.В., Фомин В.В. Кардиоренальные взаимоотношения: клиническое значение и роль в патогенезе заболеваний сердечно-сосудистой системы и почек. Терапевтический архив. 2004;6:39-46. http://www.mediasphera.ru/journals/terapevt.
  5. Томилина Н.А., Волгина Г.В., Бикбов Б.Т. Ким И.Г. Проблема сердечно-сосудистых заболеваний при хронической почечной недостаточности. Нефрология и диализ. 2003;5(1): 15-24. http://www.nephro.ru.
  6. Екард К.У. Сердечно-сосудистые последствия почечной анемии и терапия эритропоэтином. Нефрология и диализ. 2000;3:181-188. http://www.nephro.ru.
  7. Foley RN, Parfrey PS, Morgan J, Barré PE, Campbell P, Cartier P, Coyle D, Fine A, Handa P, Kingma I, Lau CY, Levin A, Mendelssohn D, Muirhead N, Murphy B, Plante RK, Posen G, Wells GA. Effect of hemoglobin levels in hemodialysis patients with asymptomatic cardiomyopathy. Kidney Int. 2000;58:1325-1335. PMID: 10972697.
  8. Бикбов Б.Т., Кирхман В.В., Томилина H.A. Предикторы летального исхода у больных на гемодиализе. Нефрология и диализ. 2004;4(2):154-163. http://www.nephro.ru.
  9. Yilmaz MI, Solak Y, Covic A, Goldsmith D, Kanbay M. Renal anemia of inflammation: the name is self-explanatory. Blood Purif. 2011;32:220-225. PMID: 21829013 doi: 10.1159/000328037.
  10. Locatelli F, Covic A, Eckardt KU, Wiecek A, Vanholder R. ERA-EDTA ERBP. Advisory Board. Anaemia management in patients with chronic kidney disease: a position statement by the Anaemia Working Group of European Renal Best Practice (ERBP). Nephrol Dial Transplant. 2009;24:348-354. PMID: 19037082. doi: 10.1093/ndt/gfn653.
  11. Беленков Ю.Н., Мареев В.Ю. Принципы рационального лечения сердечной недостаточности. М.; 2000:266. http://lib.ossn.ru/journals/RHFJ.
  12. Kidney Disease: Improving Global Outcomes (KDIGO) Anemia Work Group. KDIGO Clinical Practice Guideline for Anemia in Chronic Kidney Disease. Kidney Int. 2012;2:114-164. www.kidney-international.org.
  13. Remme WJ, Swedberg K. Guidelines for the diagnosis and treatment of chronic heart failure. Task force for the diagnosis and treatment of chronic heart failure, European Society of Cardiology. Eur Heart J. 2001;22:1527-1560. PMID: 11492984.
  14. Jicheng L, Ehteshami P, Sarnak MJ, Tighiouart H, Jun M, Ninomiya T, Foote C, Rodgers A, Zhang H, Wang H, Strippoli FM, Perkovic V. Effects of intensive blood pressure lowering on the progression of chronic kidney disease: a systematic review and meta-analysis. CMAJ. 2013;185(11):949-957. PMCID: PMC3735743. doi: 10.1503/cmaj.121468.
  15. Wachtell K, Ibsen H, Olsen MH, Borch-Johnsen K, Lindholm LH, Mogensen CE, Dahlöf B, Devereux RB, Beevers G, de Faire U, Fyhrquist F, Julius S, Kjeldsen SE, Kristianson K, Lederballe-Pedersen O, Nieminen MS, Okin PM, Omvik P, Oparil S, Wedel H, Snapinn SM, Aurup P. Albuminuria and cardiovascular risk in hypertensive patients with left ventricular hypertrophy: the LIFE study. Ann Intern Med. 2003;139:901. PMID: 14644892
  16. Vanholder R, Massy Z, Argiles A, Spasovski G, Verbeke F, Lameire N. Chronic kidney disease as cause of cardiovascular morbidity and mortality. Nephrol Dial Transplant. 2005;200:1048-1056. PMID: 15814534
  17. Roger SD, Locatelli F, Woitas RP, Laville M, Tobe SW, Provenzano R, Golper TA, Ruangkanchanasetr P, Lee HY, Wu KD, Nowicki M, Ladanyi A, Martínez-Castelao A, Beyer U, Dougherty FC C.E.R.A., once every 4 weeks corrects anaemia and maintains haemoglobin in patients with chronic kidney disease not on dialysis. Nephrol Dial Transplant. 2011;26:3980-3986. doi: 10.1093/ndt/gfr160.
  18. Sánchez-Fructuoso AI, Ruiz JC, Torregrosa JV, González E, Gómez E, Gallego RJ, Troya MI, Jimenez C, Llamas F, Romero R, Bernis C,Crespo JF, Guirado L. Anemia control in renal transplant recipients receiving continuous erythropoietin receptor activator (C.E.R.A.) treatment: the AnemiaTrans Study. Adv Ther. 2012;29(11):979-991. doi: 10.1007/s12325-012-0063-3.
  19. Valderrabano F, Jofre R, Lopez-Gomez JM. Quality of life in end-stage renal disease patients. Am JKidney Dis. 2001;38(3);443-464. PMID: 11532675, S0272638601973688.
  20. Levey AS, de Jong PE, Coresh J, El Nahas M, Astor BC, Matsushita K, Gansevoort RT, Kasiske BL, Eckardt KU. The definition, classification, and prognosis of chronic kidney disease: a KDIGO controversies conference report. Kidney Int. 2011;80:17-28. doi: 10.1038/ki.2010.483.
  21. Van Biesen W, De Bacquer D, Verbeke F, Delanghe J, Lameire N, Vanholder R. The glomerular filtration rate in an apparently healthy population and its relation with cardiovascular mortality during 10 years. Eur Heart J. 2007;28(4):478-483.
  22. Cai Q, Lu, XZ, Lu Y, Wang AY-M. Longitudinal Changes of Cardiac Structure and Function in CKD (CASCADE Study). JASN. 2014;25(7):1599-1608. doi: 10.1681/asn.2013080899.
  23. Liu M, Li XC, Lu L, Cao Y, Sun RR, Chen S, Zhang PY. Cardiovascular disease and its relationship with chronic kidney disease. Eur Rev Med Pharmacol Sci. 2014;18(19):2918-2926.
  24. Mases A, Sabaté S, Guilera N, Sadurní M, Arroyo R, Fau M, Rojo A, Castillo J, Bover J, Sierra P, Canet J. Preoperative estimated glomerular filtration rate and the risk of major adverse cardiovascular and cerebrovascular events in non-cardiac surgery. Br J Anaesth. 2014;113(4):644-651. doi: 10.1093/bja/aeu134.

Supplementary files

Supplementary Files
Action
1. JATS XML
Download

Copyright (c) 2016 Consilium Medicum

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
 

Address of the Editorial Office:

  • Alabyan Street, 13/1, Moscow, 127055, Russian Federation

Correspondence address:

  • Alabyan Street, 13/1, Moscow, 127055, Russian Federation

Managing Editor:

  • Tel.: +7 (926) 905-41-26
  • E-mail: e.gorbacheva@ter-arkhiv.ru

 

 © 2018-2021 "Consilium Medicum" Publishing house


This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies