cardiovascularКардиоваскулярная терапия и профилактикаCardiovascular Therapy and Prevention1728-88002619-0125«SILICEA-POLIGRAF» LLCcardiovascular-1548Research ArticleАРТЕРИАЛЬНАЯ ГИПЕРТОНИЯARTERIAL HYPERTENSIONСравнительное исследование различных методов оценки функционального состояния почек у больных артериальной гипертониейComparison of various renal function assessment methods in patients with arterial hypertensionВиллевальдеС. В.VillevaldeS. V.villevaldes@mail.ruГудгалисН. И.GudgalisN. I.villevaldes@mail.ruЕфремовцеваМ. А.EfremovtsevaM. A.villevaldes@mail.ruКобалаваЖ. Д.KobalavaZh. D.villevaldes@mail.ruРоссийский университет дружбы народов, г. МоскваRussian University of People’s Friendship. Moscow200820082008742129Copyright © Виллевальде С.В., Гудгалис Н.И., Ефремовцева М.А., Кобалава Ж.Д., 20082008Виллевальде С.В., Гудгалис Н.И., Ефремовцева М.А., Кобалава Ж.Д.Villevalde S.V., Gudgalis N.I., Efremovtseva M.A., Kobalava Z.D.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://cardiovascular.elpub.ru/jour/article/view/1548Цель

Цель. Оценить роль расчетной скорости клубочковой фильтрации (СКФ), определения микроальбуминурии (МАУ), цистатина С в диагностике поражения почек у больных артериальной гипертонией (АГ) с нормальным или незначительно повышенным уровнем креатинина сыворотки.

Материал и методы

Материал и методы. У 114 больных нелеченной АГ без сахарного диабета (СД) (средний возраст 53,0+1,0 года, креатинин 94,3+1,7 мкмоль/л) и 158 больных АГ и СД (АГ + СД) (средний возраст 56,2+0,7 года, креатинин 81,6+1,2 мкмоль/л) определяли креатинин сыворотки, МАУ по отношению альбумин/креатинин мочи, рассчитывали СКФ по формуле Кокрофта-Гаулта (СКФ1), MDRD (СКФ2). У больных АГ + СД также определяли цистатин С.

Результаты

Результаты. Среди больных АГ без СД и нормальным уровнем креатинина у 18,8 % выявлено снижение СКФ2 <60 мл/мин/1,73 м2, не обнаружено снижения СКФ1 <60 мл/мин. МАУ имела место у 7 (6,1 %) больных АГ без СД, у 1 пациента МАУ сопровождалась снижением СКФ2 <60 мл/мин/1,73 м2. Определение сочетания креатинина сыворотки, МАУ, СКФ2 позволили определить субклиническое поражение почек у 42,1 % больных АГ без СД, при использовании СКФ1 - у 21,9 %. В группе АГ + СД МАУ выявлена у 12 (7,6 %) больных; у всех пациентов с МАУ уровень креатинина в пределах нормы, у 2 (16,7 %) пациентов СКФ2 <60 мл/мин/1,73 м2. В группе АГ + СД цистатин С отрицательно связан с СКФ2 (г=-0,72; р<0,001), но не с СКФ1.

Заключение

Заключение. Сочетанное определение креатинина сыворотки, МАУ, расчет СКФ повышают возможность определения субклинического поражения почек у больных АГ. Цистатин С у больных АГ + СД чувствителен к обнаружению ранних нарушений функции почек.

 

 

Aim

Aim. To evaluate the role of calculated glomerular filtration rate (GFR), microalbuminuria (MAU) and cystatin С assessment in renal pathology diagnostics among patients with arterial hypertension (AH) and normal or mildly elevated serum creatinine level.

Material and methods

Material and methods. In 114 non-diabetic patients with non-treated AH (age 53,0+1,0 years, creatinine 94,3+1,7 mkmol/1) and 158 patients with AH and diabetes mellitus, DM (age 56,2+0,7 years, creatinine 81,6+1,2 mkmol/1), serum creatinine, MAU by albumin/urine creatinine ratio, and calculated GFR by Cockroft-Gault and MDRD formulas (GFRl, GFR2) were assessed. In patients with AH and DM, cystatin С level was also measured.

Results

Results. Among non-diabetic AH patients with normal creatinine level, decreased GFR2<60 ml/min/1,73 m2 but no GFRl reduction <60 ml/min/1,73 m2 was observed in 18,8%. MAU was registered in 7 non-diabetic AH patients (6,1%); in one participant, MAU was combined with decreased GFR2<60 ml/min/1,73 m2. Based on serum creatinine, MAU and GFR2 or GFRl measurement, subclinical renal pathology was diagnosed in 42,1% or 21,9% non-diabetic AH participants, respectively. Among subjects with AH and DM, MAU was observed in 12 (7,6%); in all patients with MAU creatinine level was normal; in 2 patients GFR2 was reduced <60 ml/mini,73 m2. In AH + DM group, cystatin С level was inversely related to GFR2 (r=-0,72; p<0,001), but not to GFRl.

Conclusion

Conclusion. Combined measurement of serum creatinine, MAU and GFR levels improves the diagnostics of subclinical renal pathology in AH patients. In patients with AH and DM, cystatin С is sensitive to early renal dysfunction.

артериальная гипертониясахарный диабетрасчетная скорость клубочковой фильтрациицистатин Смикроальбуминурияarterial hypertensiondiabetes mellituscalculated glomerular filtration ratecystatin CmicroalbuminuriaReferencesМухин Н.А. Снижение скорости клубочковой фильтрации -общепопуляционный маркер неблагоприятного прогноза. Тер архив 2007; 6: 5-10.Мухин Н.А. Снижение скорости клубочковой фильтрации -общепопуляционный маркер неблагоприятного прогноза. Тер архив 2007; 6: 5-10.Mancia G., De Backer G., Dominiczak A., et al. 2007 Guidelines for the Management of Arterial Hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens 2007; 25: 1105-87.Mancia G., De Backer G., Dominiczak A., et al. 2007 Guidelines for the Management of Arterial Hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens 2007; 25: 1105-87.Al-Ahmad A., Rand W.M., Manjunath G., et al. Reduced kidney function and anemia as risk factors for mortality in patients with left ventricular dysfunction. JACC 2001; 38: 955-62.Al-Ahmad A., Rand W.M., Manjunath G., et al. Reduced kidney function and anemia as risk factors for mortality in patients with left ventricular dysfunction. JACC 2001; 38: 955-62.National Kidney Foundation. K/DOQI Clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis 2002; 39(Suppl 1): SI-266.National Kidney Foundation. K/DOQI Clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis 2002; 39(Suppl 1): SI-266.Brosius FC III, Hostetter TH, Kelepouris E, et al. AHA Science advisory on detection of kidney disease in patients with or at increased risk of cardiovascular disease. Circulation 2006; 114: 1083-7.Brosius FC III, Hostetter TH, Kelepouris E, et al. AHA Science advisory on detection of kidney disease in patients with or at increased risk of cardiovascular disease. Circulation 2006; 114: 1083-7.Vassalotti J.A., Stevens L.A., Levey A.S. Testing for chronic kidney disease: a position statement from the National Kidney Foundation. Am J Kidney Dis 2007; 50(2): 169-80.Vassalotti J.A., Stevens L.A., Levey A.S. Testing for chronic kidney disease: a position statement from the National Kidney Foundation. Am J Kidney Dis 2007; 50(2): 169-80.Pucci L., Triscornia S., Lucchesi D., et al. Cystatin С and estimates of renal function: searching for a better measure of kidney function in diabetic patients. Clin Chem 2007; 53: 480-8.Pucci L., Triscornia S., Lucchesi D., et al. Cystatin С and estimates of renal function: searching for a better measure of kidney function in diabetic patients. Clin Chem 2007; 53: 480-8.Watanabe S., Okura T., Liu J., et al. Serum cystatin С level is a marker of end-organ damage in patients with essential hypertension. Hypertens Res 2003; 26: 895-9.Watanabe S., Okura T., Liu J., et al. Serum cystatin С level is a marker of end-organ damage in patients with essential hypertension. Hypertens Res 2003; 26: 895-9.Cockcroft D.W., Gault M.H. Prediction of creatinine clearance from serum creatinine. Nephron 1976; 16: 31-41.Cockcroft D.W., Gault M.H. Prediction of creatinine clearance from serum creatinine. Nephron 1976; 16: 31-41.Levey A.S., Bosch J.P., Lewis J.B., et al. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med 1999; 130: 461-70.Levey A.S., Bosch J.P., Lewis J.B., et al. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med 1999; 130: 461-70.Hoek F.J., Kemperman FAW, Krediet R.T. A comparison between cystatin C, plasma creatinine and the Cockcroft and Gault formula for the estimation of glomerular filtration rate. Nephrol Dial Transplant 2003; 18: 2024-31.Hoek F.J., Kemperman FAW, Krediet R.T. A comparison between cystatin C, plasma creatinine and the Cockcroft and Gault formula for the estimation of glomerular filtration rate. Nephrol Dial Transplant 2003; 18: 2024-31.Larsson A., Malm J., Grubb A., et al. Calculation of glomerular filtration rate expressed in mL/min from plasma cystatin С values in mg/L. Scand J Clin Lab Invest 2004; 64: 25-30.Larsson A., Malm J., Grubb A., et al. Calculation of glomerular filtration rate expressed in mL/min from plasma cystatin С values in mg/L. Scand J Clin Lab Invest 2004; 64: 25-30.Beauvieux M.C., Le Moigne F., Lasseur C., et al. New predictive equations improve monitoring of kidney function in patients with diabetes. Diabetes Care 2007; 30(8): 1988-94.Beauvieux M.C., Le Moigne F., Lasseur C., et al. New predictive equations improve monitoring of kidney function in patients with diabetes. Diabetes Care 2007; 30(8): 1988-94.Смирнов А.В., Добронравов В.А., Каюков И.Е Проблема хронической болезни почек в современной медицине. Артер гиперт 2006; 12(3): 185-93.Смирнов А.В., Добронравов В.А., Каюков И.Е Проблема хронической болезни почек в современной медицине. Артер гиперт 2006; 12(3): 185-93.Nelson A.W., Mackinnon В., Traynor J., Geddes C.C. The relationship between serum creatinine and estimated glomerular filtration rate: implications for clinical practice. Scott Med J 2006; 51(4): 5-9.Nelson A.W., Mackinnon В., Traynor J., Geddes C.C. The relationship between serum creatinine and estimated glomerular filtration rate: implications for clinical practice. Scott Med J 2006; 51(4): 5-9.Rigalleau V., Lasseur C., Perlemoine C., et al. Estimation of glomerular filtration rate in diabetic subjects: Cockcroft formula or modification of diet in renal disease study equation? Diabetes Care 2005; 28: 838-43.Rigalleau V., Lasseur C., Perlemoine C., et al. Estimation of glomerular filtration rate in diabetic subjects: Cockcroft formula or modification of diet in renal disease study equation? Diabetes Care 2005; 28: 838-43.Lin J., Knight E.L., Hogan M.L., Singh A.K. A comparison of prediction equations for estimating glomerular filtration rate in adults without kidney disease. J Am Soc Nephrol 2003; 14: 2573-80.Lin J., Knight E.L., Hogan M.L., Singh A.K. A comparison of prediction equations for estimating glomerular filtration rate in adults without kidney disease. J Am Soc Nephrol 2003; 14: 2573-80.Rostoker G., Andrivet P., Pham I., et al. A modified Cockcroft-Gault formula taking into account the body surface area gives a more accurate estimation of the glomerular filtration rate. J Am Soc Nephrol 2007; 20(5): 576-85.Rostoker G., Andrivet P., Pham I., et al. A modified Cockcroft-Gault formula taking into account the body surface area gives a more accurate estimation of the glomerular filtration rate. J Am Soc Nephrol 2007; 20(5): 576-85.Poggio E.D., Wang X., Greene T., et al. Performance of the MDRD and Cockcroft Gault equations in the estimation of GFR in health and in chronic kidney disease. J Am Soc Nephrol 2005; 16: 459-66.Poggio E.D., Wang X., Greene T., et al. Performance of the MDRD and Cockcroft Gault equations in the estimation of GFR in health and in chronic kidney disease. J Am Soc Nephrol 2005; 16: 459-66.Froissart M., Rossert J., Jacquot C., et al. Predictive performance of the modification of diet in renal disease and Cockcroft-Gault equations for estimating renal function. J Am Soc Nephrol 2005; 16: 763-73.Froissart M., Rossert J., Jacquot C., et al. Predictive performance of the modification of diet in renal disease and Cockcroft-Gault equations for estimating renal function. J Am Soc Nephrol 2005; 16: 763-73.Rule A.D., Larson T.S., Bergstralh E.J., etal. Using serum creatinine to estimate glomerular filtration rate: accuracy in good health and in chronic kidney disease. Ann Intern Med 2004; 141: 929-37.Rule A.D., Larson T.S., Bergstralh E.J., etal. Using serum creatinine to estimate glomerular filtration rate: accuracy in good health and in chronic kidney disease. Ann Intern Med 2004; 141: 929-37.Finney H., Bates C.J., Price C.R. Plasma cystatin С determinations in a healthy elderly population. Arch Gerontol Geriatr 1999; 29: 75-94.Finney H., Bates C.J., Price C.R. Plasma cystatin С determinations in a healthy elderly population. Arch Gerontol Geriatr 1999; 29: 75-94.Wasen E., Isoaho R., Mattila K., et al. Estimation of glomerular filtration rate in the elderly: a comparison of creatinine-based formulae with serum cystatin C. J Intern Med 2004; 256: 70-8.Wasen E., Isoaho R., Mattila K., et al. Estimation of glomerular filtration rate in the elderly: a comparison of creatinine-based formulae with serum cystatin C. J Intern Med 2004; 256: 70-8.Roderick P.J., Atkins R.J., Smeeth L., et al. Detecting chronic kidney disease in older people; what are the implications? Age Ageing 2008; 37(2): 179-86.Roderick P.J., Atkins R.J., Smeeth L., et al. Detecting chronic kidney disease in older people; what are the implications? Age Ageing 2008; 37(2): 179-86.O'Hare A.M., Bertenthal D., Covinsky K.E., et al. Mortality risk stratification in chronic kidney disease: one size for all ages? J Am Soc Nephrol 2006; 17: 846-53.O'Hare A.M., Bertenthal D., Covinsky K.E., et al. Mortality risk stratification in chronic kidney disease: one size for all ages? J Am Soc Nephrol 2006; 17: 846-53.Jong P.E., Halbesma N., Gansevoort R.T. Screening for early chronic kidney disease -what method fits best? Nephrol Dial Transplant 2006; 21: 2358-61.Jong P.E., Halbesma N., Gansevoort R.T. Screening for early chronic kidney disease -what method fits best? Nephrol Dial Transplant 2006; 21: 2358-61.McCuUough P.A., Li S., Jurkovitz C.T., et al. Kidney Early Evaluation Program Investigators. CKD and cardiovascular disease in screened high-risk volunteer and general populations: the Kidney Early Evaluation Program (KEEP) and National Health and Nutrition Examination Survey (NHANES) 1999-2004. Am J Kidney Dis 2008; 51(4 Suppl 2): S38-45.McCuUough P.A., Li S., Jurkovitz C.T., et al. Kidney Early Evaluation Program Investigators. CKD and cardiovascular disease in screened high-risk volunteer and general populations: the Kidney Early Evaluation Program (KEEP) and National Health and Nutrition Examination Survey (NHANES) 1999-2004. Am J Kidney Dis 2008; 51(4 Suppl 2): S38-45.New J.P., Middleton R.J., Klebe B., et al. Assessing the prevalence, monitoring and management of chronic kidney disease in patients with diabetes compared with those without diabetes in general practice. Diabet Med 2007; 24(4): 364-9.New J.P., Middleton R.J., Klebe B., et al. Assessing the prevalence, monitoring and management of chronic kidney disease in patients with diabetes compared with those without diabetes in general practice. Diabet Med 2007; 24(4): 364-9.Middleton R.J., Foley R.N., Hegarty J., et al. The unrecognized prevalence of chronic kidney disease in diabetes. Nephrol Dial Transplant 2006; 21: 88-92.Middleton R.J., Foley R.N., Hegarty J., et al. The unrecognized prevalence of chronic kidney disease in diabetes. Nephrol Dial Transplant 2006; 21: 88-92.Tanaka A., Suemaru K.,Arakil H. A New Approach for Evaluating Renal Function and Its Practical Application. J Pharmacol Sci 2007; 105: 1-5.Tanaka A., Suemaru K.,Arakil H. A New Approach for Evaluating Renal Function and Its Practical Application. J Pharmacol Sci 2007; 105: 1-5.Levin A., Cystatin C., serum creatinine, and estimates of kidney function: searching for better measures of kidney function and cardiovascular risk. Ann Intern Med 2005; 142: 586-8.Levin A., Cystatin C., serum creatinine, and estimates of kidney function: searching for better measures of kidney function and cardiovascular risk. Ann Intern Med 2005; 142: 586-8.Filler G., Bokenkamp A., Hofmann W., et al. Cystatin С as a marker of GFR-history, indications, and future research. Clin Biochem 2005; 38: 1-8.Filler G., Bokenkamp A., Hofmann W., et al. Cystatin С as a marker of GFR-history, indications, and future research. Clin Biochem 2005; 38: 1-8.Laterza O.F., Price C.P., Scott M.G. Cystatin C: an improved estimator of glomerular filtration rate? Clin Chem 2002; 48: 699-707.Laterza O.F., Price C.P., Scott M.G. Cystatin C: an improved estimator of glomerular filtration rate? Clin Chem 2002; 48: 699-707.Tanaka A., Suemaru K., Otsuka T., et al. Estimation of the initial dose setting of vancomycin therapy using cystatin С as a new marker of renal function. Ther Drug Monit 2007; 29: 261-4.Tanaka A., Suemaru K., Otsuka T., et al. Estimation of the initial dose setting of vancomycin therapy using cystatin С as a new marker of renal function. Ther Drug Monit 2007; 29: 261-4.Dharnidharka V.R., Kwon C., Stevens G. Serum cystatin С is superior to serum creatinine as a marker of kidney function: a meta-analysis. Am J Kidney Dis 2002; 40: 221-6.Dharnidharka V.R., Kwon C., Stevens G. Serum cystatin С is superior to serum creatinine as a marker of kidney function: a meta-analysis. Am J Kidney Dis 2002; 40: 221-6.Gerhardt T., Poge U., Stoffel-Wagner B., et al. Estimation of glomerular filtration rates after orthotopic Liver Transplantation: Evaluation of cystatin C-based equations. Liver Transpl 2006; 12: 1667-72.Gerhardt T., Poge U., Stoffel-Wagner B., et al. Estimation of glomerular filtration rates after orthotopic Liver Transplantation: Evaluation of cystatin C-based equations. Liver Transpl 2006; 12: 1667-72.Poge U., Gerhardt T., Stoffel-Wagner B., et al. Cystatin C-based calculation of glomerular filtration rate in kidney transplant recipients. Kidney Int 2006; 70: 204-10.Poge U., Gerhardt T., Stoffel-Wagner B., et al. Cystatin C-based calculation of glomerular filtration rate in kidney transplant recipients. Kidney Int 2006; 70: 204-10.Shlipak M.G., Sarnak M.J., Katz R., et al. Cystatin С and the risk of death and cardiovascular events among elderly persons. N Engl J Med 2005; 352: 2049-60.Shlipak M.G., Sarnak M.J., Katz R., et al. Cystatin С and the risk of death and cardiovascular events among elderly persons. N Engl J Med 2005; 352: 2049-60.Shlipak M.G., Katz R., Fried L.F., et al. Cystatin-C and mortality in elderly persons with heart failure. JACC 2005; 45: 268-71.Shlipak M.G., Katz R., Fried L.F., et al. Cystatin-C and mortality in elderly persons with heart failure. JACC 2005; 45: 268-71.Sarnak M.J., Katz R., Stehman-Breen C.O., et al. Cystatin С concentration as a risk factor for heart failure in older adults. Ann Intern Med 2005; 142: 497-505.Sarnak M.J., Katz R., Stehman-Breen C.O., et al. Cystatin С concentration as a risk factor for heart failure in older adults. Ann Intern Med 2005; 142: 497-505.

The authors declare that there are no conflicts of interest present.