PHARMACOLOGICAL CORRECTION OF METABOLIC SYNDROME AND CHRONIC KIDNEY DISEASE
Abstract
Aim. Optimization of pharmacotherapy of patients with metabolic syndrome and chronic kidney disease according to the nephroprotective properties of antihypertensive drugs.
Methods. 81 patients (38 male, 43 female, age 29-79 years, mean age 53,4± 11,6 years) with metabolic syndrome and normal kidney function were included into the study. In all patients estimated glomerular filtration rate (eGFR) according to the Cockroft-Gault formula and microalbuminuria were determined. Antihypertensive and nephroprotective efficacy of zofenopril, losartan, nebivolol and fixed combination of lisinopril and hydrochlorothiazide were assessed.
Results. 57 (70,4%) patients with metabolic syndrome had renal function deterioration: 19 (23,5%) - hyperfiltration (eGFR >110 ml/min/1,73 m2), 38 (46,9%) - hypofiltration (eGFR <90 ml/min/1,73 m2). Progression of chronic kidney disease was connected with increasing age. Endothelin-1 concentration increased according to blood pressure rise. Zofenopril, losartan, nebivolol and fixed combination of lisinopril and hydrochlorothiazide demonstrated antihypertensive and nephroprotective effect in methabolic syndrome.
Conclusion. Changes in eGFR can be found up to 2/ 3 patients with metabolic syndrome and can be corrected by antihypertensive drugs.
About the Authors
T. E. Morozova
ГОУ ВПО «Первый Московский государственный медицинский университет им. И.М. Сеченова Минздравсоцразвития России»
Russian Federation
Russian Federation
E. M. Shilov
ГОУ ВПО «Первый Московский государственный медицинский университет им. И.М. Сеченова Минздравсоцразвития России»
Russian Federation
Russian Federation
A. V. Beloborodova
ГОУ ВПО «Первый Московский государственный медицинский университет им. И.М. Сеченова Минздравсоцразвития России»
Russian Federation
Russian Federation
References
1. Еремина Ю.Н., Леонова М.В. Селективная микропротеинурия: связь с другими факторами риска у больных артериальной гипертензией / / Леч. дело. — 2007. — № 2. - С. 38-42.
2. Tapeee Е.М. Гипертоническая болезнь. — М.: Медгиз, 1948.
3. Chen Muntner R, Hamm L.L. et at. The metabolic syndrome and chronic kidney disease in U.S. adults / / Ann. Intern. Med. - 2004. - Vol. 140, N 3. - P. 167-174.
4. Clinical practice guidelines for chronic kidney disease: evaluation, classification and stratification. — National Kidney Foundation, 2002. — P. 1—80.
5. Coresh J., Stevens L., Levey A.S. Chronic kidney disease is common: what do we do next? / / Nephrol. Dial Transplant. - 2008. - Vol. 23. - P. 1122-1125.
6. Ervin R.B. Prevalence of metabolic syndrome among adults 20 years of age and over, by sex, age, race and ethnicity, and body mass index: United States, 2003-2006 // National Health Statistics Reports. — 2009. — Vol. 13. — P. 1—8.
7. Ford E.S. Prevalence of the metabolic syndrome defined by the International Diabetes Federation among adults in the U.S. / / Diabetes Care. — 2005. — Vol. 28, N 11. — P. 2745-2749.
8. Kopyt N.P. Chronic kidney disease: the new silent killer // JAOA. - 2006. - Vol. 106, N 3. - P. 133-136.
9. Kurella M., Lo J.C., Chertow G.M. Metabolic syndrome and the risk for chronic kidney disease among nondibetic adults / / J. Am. Soc. Nephrol. - 2005. - Vol. 16. - P. 2134-2140.
10. Lieb W., Mayer B., Stritzke J. et al. Association of lowgrade urinary albumin excretion with left ventricular hypertrophy in the general population / / Nephrol. Dial. Transplant. - 2006. - Vol. 21, N 10. - P. 2780-2787.
11. Saydah S., Eberhardt M., Rios-Burrows N. et al. Prevalence of Chronic Kidney Disease and Associated Risk Factors in the United States, 1999-2004 / / JAMA. — 2007. - Vol. 297. - P. 1767-1768.
12. Schelling J.R., Sedor J.A. The Metabolic syndrome as a risk factor for chronic kidney disease: more than a fat chance? / / J. Am. Soc. Nephrol. — 2004. — Vol. 15. — P. 2773-2774.
13. Schmieder R.E., Schrader J., Zidek W. etal. Low-grade albuminuria and cardiovascular risk. What is the evidence? // Clin. Res. Cardiol. - 2007. - Vol. 96. - P. 247-257.
14. Stevens L.A., Coresh J., Greene T., Levey A.S. Assessing kidney function — measured and estimated glomerular filtration rate // Med. Prog. — 2006. — Vol. 354. — P. 2473-2483.
15. Tanaka H., Shiohira Y, Uezu Y. et al. Metabolic syndrome and chronic kidney disease in Okinawa, Japan / / Kidney Int. - 2006. - Vol. 69. - P. 369-374.
16. Vanholder R., Massy Z., ArgilesA. etal. Chronic kidney disease as cause of cardiovascular mobility and mortality // Nephrol. Dial. Transplant. — 2005. — Vol. 20, N 6. — P. 1048-1056.
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