Risk factors, prevalence and rates of chronic kidney disease progression in outpatient patients with arterial hypertension


DOI: https://dx.doi.org/10.18565/therapy.2023.3.7-14

Sigitova O.N., Bogdanova A.R., Saubanova E.I.

1) Kazan State Medical University of the Ministry of Healthcare of Russia; 2) Kazan State Medical Academy – a branch of Russian Medical Academy of Continuous Professional Education of the Ministry of Healthcare of Russia; 3) Kazan (Privolzhsky) Federal University; 4) Professor K.Sh. Zyyatdinov Central State Clinical Hospital No. 18, Kazan
Abstract. Arterial hypertension (AH) is a common cause of chronic kidney disease (CKD) and its progression to end-stage kidney failure. Prevalence of CKD in patients with hypertension is significantly higher than the average in the adult population and is comparable to that in high-risk groups (diabetes mellitus, cardiovascular disease).
The aim of the research is to study the prevalence of CKD, comorbid diseases, risk factors, progression rates in outpatients with stage II–III of AH.
Material and methods. 968 outpatients with stage II–III of essential hypertension were examined for the presence of CKD according to the following criteria: albuminuria >30 mg/day and/or albumin/creatinine (A/Cr) in a single portion of urine >30 mg/g and/or GFR <60 ml/min/m2 according to CKD-EPI. In the groups of patients without CKD (n=71) and with CKD (n=49), a survey was performed, including an assessment of CKD risk factors, the structure and function of the kidneys; in 43 patients with CKD in the dynamics after 5 years, the clinic, renal function and the rate of progression of CKD were studied.
Results. CKD was detected in 18,7% of outpatients with hypertension, GFR was 71 ml/min/m2. The duration of hypertension in patients with CKD was longer, the duration of hypertension before CKD was 11,3±1,3 years, and the onset of hypertension was earlier (at 40,5 years) comparatively to the group without CKD (46,3 years). The levels of blood pressure, atherogenic lipids, the proportion of smokers, smoking index, BMI in the group with CKD were higher comparatively to the group without CKD.
Conclusion. The rate of decrease in GFR in patients with AH and CKD before being taken under observation was 12,05 ml/min/year. Risk factors for the development of CKD were identified: they are LDL, SBP, BMI, smoking index, earlier onset of AH and longer duration of AH. A formula for calculating the probability of developing CKD under the influence of these factors has been developed. After 5 years of observation and treatment, the level of blood pressure remained insufficiently controlled, for other risk factors there was a slight positive tendency without reaching the target levels. GFR for 5 years decreased from 71+3,1 to 45,2±1,6 ml/min/m2. The rate of progression of CKD slowed down to 5,7 ml/min/year, but still indicated CKD progression.
Keywords: progression rates of chronic kidney disease, arterial hypertension, chronic kidney disease, risk factors
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About the Autors

Olga N. Sigitova, MD, professor of the Department of polyclinic therapy and general medical practice, Kazan State Medical University of the Ministry of Healthcare of Russia, professor of the Department of urology of Kazan
State Medical Academy – a branch of Russian Medical Academy of Continuous Professional Education of the Ministry of Healthcare of Russia. Address: 420012, Kazan, 49 Butlerova Str. E-mail: osigit@rambler.ru. ORCID: https://orcid.org/0000-0001-8983-245X
Alina R. Bogdanova, PhD in Medical Sciences, associate professor of the Department of internal medicine, Kazan (Privolzhsky) Federal University. Address: 420008, Kazan, 18 Kremlyovskaya Str. E-mail: _alinochka@mail.ru. ORCID: https://orcid.org/0000-0001-6953-464X
Elvira I. Saubanova, PhD in Medical Sciences, deputy chief physician for the outpatient Department, cardiologist at Professor K.Sh. Zyyatdinov Central State Clinical Hospital No. 18. Address: 420101, Kazan, 2 Kh. Mavlyutova Str. E-mail: elvirabik@mail.ru


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