ISSN 2415-3060 (print), ISSN 2522-4972 (online)
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УЖМБС 2021, 6(6): 85–92
Clinical Medicine

Nephrological Aspects of Metabolic Syndrome in Patients with Chronic Kidney Disease on Peritoneal Dialysis with Different Clinical Variants of Coronary Heart Disease

Andonieva N. M., Huts O. A., Dubovik M. Ya., Valkovska T. L., Kolupayev S. M.

The purpose of the study was to identify the components of the metabolic syndrome most characteristic of different clinical variants of ischemic heart disease in patients with chronic kidney disease on peritoneal dialysis. Materials and methods. 114 patients took part in the study. The average duration of peritoneal dialysis therapy was 53 months. Clinical variants of ischemic heart disease were determined by angina attacks, by painless myocardial ischemia detected by ECG-load cycle ergometer test, by increasing phenomena of ischemic dilated cardiomyopathy (diastolic dysfunction, calcification and atheromatosis of aorta and heart valves) by echocardiographic study in dynamics and by the previous myocardial infarction episodes. All patients were accordingly divided into 5 clinical groups, one of which was patients with no evidence of coronary heart disease (comparison group). The data were processed using the SPSS 19.0 for Windows statistical software package. Results and discussion. Considering different components of metabolic syndrome: body weight, arterial hypertension, dyslipidemia, the highest body mass index in patients on peritoneal dialysis was found in the group of patients suffering from ischemic dilated cardiomyopathy. High-density lipoproteins were lowest in the group of patients who underwent myocardial infarction. Hypertriglyceridemia was most pronounced in the group of patients with painless myocardial ischaemia. Low-density lipoproteins were highest in the group of patients with stable angina pectoris. Mean arterial pressure was highest in the group of patients with stable angina and in the group of patients with painless myocardial ischaemia. Conclusion. The highest number of patients with metabolic syndrome was found in the groups of patients with non-painful myocardial ischemia and ischemic dilated cardiomyopathy (67% and 51% respectively). In the group of patients with non-painful myocardial ischaemia (high acute coronary risk group), metabolic syndrome was diagnosed by four features: visceral obesity, raised blood sugar, arterial hypertension, raised very low density of lipoproteins and triglycerides. In the group of patients with ICDMP (group of patients with severe diastolic heart failure), metabolic syndrome was diagnosed by three features: visceral obesity, elevated blood sugar and low density lipoproteins. Thus, a vector for further research may be to investigate the effect of complexly corrected components of the metabolic syndrome on the occurrence of acute coronary risks or progression of chronic heart failure in patients with chronic kidney disease on peritoneal dialysis

Keywords: chronic kidney disease, peritoneal dialysis, clinical variants of ischemic heart disease, metabolic syndrome

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  1. Bessesen DH. Evaluation and management of obesity Hanley and Belfus Inc. Philadelphia; 2006. 24 p.
  2. Koning L, Merchant AT, Pogue J. Waist circumference and waist-to-hip ratio as predictors of cardiovascular events: meta-regression analysis of prospective studies. Eur Heart J. 2007; 7(28): 850-6. PMid: 17403720.
  3. Madeira FB, Silva AA, Veloso HF, Goldani MZ, Kac G, Cardoso VC, et al. Normal weight obesity is associated with metabolic syndrome and insulin resistance in young adults from a middle-income country. PLoS One. 2013; 8: e60673. PMid: 23556000. PMCid: PMC3610876.
  4. Yanai H, Yoshida H. Beneficial effects of adiponectin on glucose and lipid metabolism and atherosclerotic progression: mechanisms and perspectives. Int J Mol Sci. 2019;20(5):1190. PMid: 30857216. PMCid: PMC6429491.
  5. Zhao Y, Burkow D, Song B. Mathematically modeling the role of triglyceride production on leptin resistance. In: Patnaik S, Jain V, Eds. Recent Developments in Intelligent Computing, Communication and Devices - Proceedings of ICCD. Adv Intell Syst Comput. 2017;752:291-301.
  6. Antonopoulos AS, Antoniades C. The role of epicardial adipose tissue in cardiac biology:classic concepts and emerging roles. J Physiol. 2017; 595 (12): 3907-3917. PMid: 28191635. PMCid: PMC5471417.
  7. Reisin E, Jack AV. Obesity and hypertension: mechanisms, cardio-renal consequences, and therapeutic approaches. Med Clin North Am. 2009;93:733-51. PMid: 19427502.
  8. Babenko AYu, Tikhonenko EV, Tsoy UA, Vasilieva EYu. Сharacteristics of eating behavior and the level of hormones regulating the appetite in patients with type 2 diabetes mellitus and body mass index more than 35. Obes Metab. 2018;15(1):30-38.
  9. United States Renal Data System. Renal Data System. Chapter 4: Cardiovascular Disease in Patients With CKD. Am J Kidn Dis. 2016;67(3):S49-S56. PMid: 26454686.
  10. Grande D., Terlizzese P., lacoviello M., Role of imaging in the evaluation of renal dysfunction in heart failure patients. World J Nephrol. 2017;6(3):123-131. PMid: 28540202. PMCid: PMC5424434.
  11. American Association of Clinical Endocrinologists и American college of Endocrinology position statement on the 2014 advanced framework for a new diagnosis of obesity as a chronic disease. Endocr Pract. 2014;20(9):978-89. PMid: 25253227. PMCid: PMC4962331.
  12. Guo F, Moellering DR, Garvey WT. The progression of cardiometabolic disease: validation of a new cardiometabolic disease staging system applicable to obesity. Obesity. 2014;22:110-8. PMid: 23894121. PMCid: PMC3866217.
  13. Druzhilov MA, Beteleva YuE, Kuznetsova TYu. Tolshchina epikardial'nogo zhira - al'ternativa okruzhnosti talii kak samostoyatel'nyy ili vtoroy kriteriy dlya diagnostiki metabolicheskogo sindroma? [Epicardial adipose tissue thickness - an alternative to waist circumference as a stand-alone or secondary main criterion in metabolic syndrome diagnostics?] Ross J Cardiol. 2014; 3(107):76-81. [Russian].
  14. Druzhilov MA, Druzhilova OYu, Beteleva YuE. Ozhireniye kak faktor serdechno-sosudistogo: aktsent na kachestvo i funktsional'nuyu aktivnost' zhirovoy tkani [Obesity as a cardiovascular risk factor: accent on quality and functional activity of adipose tissue]. Ross J Cardiol. 2015;4(120):111-7. [Russian].
  15. Öhman MK, Luo W. Perivascular Visceral Adipose Tissue Induces Atherosclerosis in Apolipoprotein E Deficient. Atherosclerosis. 2011 Nov;219(1):33-9. PMid: 21835408. PMCid: PMC3206153.
  16. Kuk JL, Church TS, Blair SN. Does measurement site for visceral and abdominal subcutaneous adipose tissue alter associations with the metabolic syndrome? Diabetes Care. 2006;29 679-84. PMid: 16505526.
  17. Coutinho T, Goel K, Corrêa De Sá D, Carter RE, Hodge DO, Kragelund C, et al. Combining body mass index with measures of central obesity in the assessment of mortality in subjects with coronary disease: Role of "normal weight central obesity". J Am Coll Cardiol. 2013; 61: 553-60. PMid: 23369419.
  18. Gonzalez-Campoy JM, St. Jeor S, Castorino K, Ebrahim A, Hurley D, Jovanovic L, et al. Clinical Practice Guidelines for Healthy Eating for the Prevention and Treatment of Metabolic and Endocrine Diseases in Adults: Cosponsored by the American Association of Clinical Endocrinologists/The American College of Endocrinology and the Obesity Society. Endocr Pract. 2013;19(3):1-82. PMid: 24129260.
  19. Klein S, Allison DB, Heymsfield SB, Kelley DE, Leibel RL, Nonas C, et al. Waist circumference and cardiometabolic risk: a consensus statement from Shaping America's Health: Association for Weight Management and Obesity Prevention, NAASO, The Obesity Society, the American Society for Nutrition and the American Diabetes Association. Am J Clin Nutr. 2007;85(5):1197-1202. PMid: 17490953.
  20. O'Neill T, Guaraldi G, Orlando G. Combined Use of Waist and Hip Circumference to Identify Abdominally Obese HIV-Infected Patients at Increased Health Risk. PLoS One. 2013;5(8):625-38. PMid: 23700409. PMCid: PMC3659108.
  21. Schlett CL, Massaro JM, Lehman SJ, Bamberg F, O'Donnell CJ, Fox CS, et al. Novel measurements of periaortic adipose tissue in comparison to anthropometric measures of obesity, and abdominal adipose tissue. Int J Obes (Lond). 2009;33:226-32. PMid: 19139753. PMCid: PMC3779879.
  22. Scherzer R, Shen W, Heymsfield SB. Intermuscular adipose tissue and metabolic associations in HIV infection. Obesity (Silver Spring). 2011 Feb;19(2): 283-91. PMid: 120539305. PMCID: PMC3731045.