Relationship between arterial pressure indexes and structura-functional condition of myocardium in patients with stage 5d chronic kidney disease


DOI: https://dx.doi.org/10.18565/therapy.2023.3.21-27

Ievlev E.N., Kazakova I.A.

1) Izhevsk State Medical Academy of the Ministry of Healthcare of Russia; 2) City Clinical Hospital No. 6 of the Ministry of Healthcare of the Udmurt Republic, Izhevsk
Abstract. Arterial hypertension (AH) is one of the risk factors for the development of left ventricular hypertrophy (LVH) in patients with chronic kidney disease (CKD).
The aim of the research is to evaluate the parameters of ABPM in patients receiving treatment with program hemodialysis, depending on the structural and functional heart condition.
Material and methods. 179 patients with stage 5d CKD (79 males and 100 females) were examined. Average age of participants was 56,9±12,2 years, their dialysis experience was 5,7±3,5 years. All patients underwent ABPM and Echo-KG examination.
Results. In examined patients, circadian rhythms of BP of the Non-dipper and Night Peaker types were revealed in SBP (81,6%; p <0,001) and DBP (73,2%; p <0,001). A correlation was fixed between the degree of nighttime decrease in SBP and DBP with LVM (r=-0,45, p <0,01; r=-0,51, p <0,01), LVMI (r=-0,55, p <0,001; r=-0,53, p <0,01). Pulse wave velocity was associated with interdialysis weight gain (r=0,55, p<0,001) and medium fibers shortening fraction (r=0,4, p<0,05). In 116 (64,8%) patients, a moderate increase in arterial stiffness index (p <0,001) was observed, which correlated with LVM (r=0.34, p<0.05) and SBP (r=0.39, p <0,05). In 135 (75,4%) patients with CKD, parasympathicotonia predominated (p <0,001). A correlation was found between the vegetative index and LVMI (r=-0,51, p<0,001) and LVMI (r=-0,44, p<0,01).
Conclusion. Most patients with stage 5d CKD have predominating parasympathicotonia, which is associated with LVMI. Moderate increase in arterial stiffness index, correlating with interdialytic weight gain takes place. BP circadian rhythm disturbance was associated with LVMI, DBP level correlated with right ventricular thickness.
Keywords: right ventricular hypertrophy, circadian rhythm of blood pressure, vascular stiffness, left ventricular remodeling, 24-hour blood pressure monitoring, hemodialysis, chronic kidney disease, left ventricular hypertrophy
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About the Autors

Evgeny N. Ievlev, PhD in Medical Sciences, associate professor of the Department of internal diseases with courses in radiation methods of diagnosis and treatment, military field therapy, Izhevsk State Medical Academy of the Ministry of Healthcare of Russia, general practitioner of the admissions department of City Clinical Hospital No. 6 of the Ministry of Healthcare of the Udmurt Republic. Address: 426000, Izhevsk, 281 Kommunarov Str. E-mail: inloja@mail.ru. ORCID: https://orcid.org/0000-0002-0395-7946
Irina A. Kazakova, MD, professor, head of the Department of internal diseases with courses in radiation methods of diagnosis and treatment, military field therapy, Izhevsk State Medical Academy of the Ministry of Healthcare of Russia. Address: 426000, Izhevsk, 281 Kommunarov Str. E-mail: i.a.kazakova@yandex.ru.
ORCID: https://orcid.org/0000-0001-7815-1536


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