The influence of renal anemia on cardiac remodelling in chronic glomerulonephritis

The relation between renal diseases and cardiovascular morbidity is known since Richard Bright times, who was the first researcher on morphology of the left ventricle hypertrophy (LVH) in renal diseases. Since these times, an abundant research was done on LVH as one of the leading risk factors for heart failure development in chronic glomerulonephritis (CGN) and of the role of anemia in renal diseases. However, until recently it is not completely known of the role of anemia in formation of structural cardiovascular changes in CGN.

Aim. To study the influence of anemia on the development of various types of LV remodelling in CGN patients of predialysis stage.

Material and methods. Totally, 137 patients studied (70 men and 67 women) at the age 16-64 y. o. (mean age — 34,7±13,0) with established CGN diagnosis at predialysis stage. Anemia was diagnosed based on KDIGO criteria of 2012. Clinical assessment included: complaints, anamnesis; physical examination with anthropometric parameters and blood pressure measurement; laboratory-instrumental assessment for diagnosis verification; biochemical measurement of serum total protein, creatinine, fibrinogen, lipid profile, C-reactive protein. For structural changes of the heart evaluation, we applied electro- and echocardiographical study. LVH and remodelling types were defined according to RCS criteria. For LVH evaluation, we calculated myocardial mass index of the LV, and higher normal limit we used was for women 109 g/m2, and for men 124 g/m2. Statistics was performed on personal computer with Excel software and “Statistica 6.0”.

Results. If anemia existed in CGN patient, there was significantly increased thickness of interventricular septum — 0,9±0,1 cm vs 0,8±0,2 cm (p<0,05) and of indexed LV mass — 115±44 g/m2 vs 96±41 g/m2 (p<0,01) comparing to CGN patients without anemia.

Conclusion. Structural changes of cardiovascular system in CGN persons does occur even in predialysis period. If anemia present, there is tendency for increase of excentric LVH and interventricular septum.

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