The structure and features of the course of chronic kidney disease in patients with coronary heart disease and comorbid diseases

Abstract

Aim. To investigate the prevalence, structure, and features of the course of chronic kidney disease (CKD) in patients with coronary heart disease (CHD) associated with comorbid diseases.

Methods. The observation group consisted of 257 patients of the Interregional Clinical Diagnostic Center (Kazan) with coronary heart disease (2014–2018): 183 males and 74 females, aged from 38 to 95 years (mean age 61.8±0.6). Observation program: clinical examination; serum creatinine and lipid profiles, the albumin/creatinine ratio in a single portion of urine, morning urine osmolality, glomerular filtration rate estimated by the CKD-EPI; renal scintigraphy, ultrasonography of the kidneys, renal Doppler ultrasound and angiography. Chronic kidney disease was diagnosed if one of the criteria was met: the glomerular filtration rate <60 ml/min/1.73 m2 or the ratio of albumin to creatinine in urine (ACR) >30 mg/g. Statistical analysis was performed by using the methods of variational statistics: determination of the arithmetic mean (M), standard error of the mean (m) and difference significance according to the Student's test (t).

Results. Examination of patients revealed the following comorbid diseases and syndromes: hypertension (90.7%), hyper- and dyslipidemia (96.5%), overweight/obesity (74.3%), diabetes mellitus (17.9%), chronic heart failure stages I–IIa according to Strazhesko–Vasilenko classification (100%). 164 (63.8%) patients were first time diagnosed with chronic kidney disease: hypertensive nephropathy — in 66.4%, ischemic renal disease — in 21.9%, diabetic nephropathy — in 2.4%, a combination of diabetic and hypertensive nephropathy — in 9.3%. 51.2% of patients had stage 2 of chronic kidney disease, 42.1% — stage 3, 6.7% — stage 4 or 5. A feature of chronic kidney disease is its latent course (absence of complaints and clinical manifestations) and, as a consequence, unidentified diagnosis at the prehospital stage, which is generally characteristic of secondary nephropathies in cardiovascular diseases and these comorbid conditions.

Conclusion. Chronic kidney disease was first diagnosed in 63.8% of patients with coronary heart disease with 1 to 5 comorbid diseases; a feature of chronic kidney disease is its secondary nature, the course of the disease is hidden by underlying and/or comorbid disease and, as a result, its late diagnosis.

Keywords

coronary heart disease / comorbidity diseases / chronic kidney disease

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