The dissertation was performed at the Department of Occupational Diseases, Clinical Immunology and Clinical Pharmacology of the Dnipro State Medical University on the basis of the Municipal Non-profit Enterprise "City Clinical Hospital № 4 of Dnipro City Council".
The dissertation study examined renal function, nutritional status and cardiovascular risk in patients with combined hypertension and chronic obstructive pulmonary disease. The study consisted of two parts: a retrospective analysis and a cross-sectional study. A retrospective analysis examined the medical records of 64 patients with hypertension, 58 patients with combined hypertension and chronic obstructive pulmonary disease, and 66 patients with chronic obstructive pulmonary disease. In a cross-sectional study, 32 patients with combined hypertension and chronic obstructive pulmonary disease (main group), 43 patients with hypertension (comparison group I), and 26 patients with chronic obstructive pulmonary disease (comparison group II) were examined.
At the retrospective stage of the study, a decrease in renal function was found in patients of three groups.
At the stage of a cross-sectional study patients determined nutritional status by bioimpedancemetry, conducted daily monitoring of blood pressure, assessed the renal function by laboratory examination of blood and urine, determined the structural and functional state of the cardiovascular system by echocardiographic examination.
For the first time, it has been proven that in the comorbid course of hypertension and COPD, predictors of decreased renal function (GFR < 60 ml/min) are increased blood cystatin C, increased BMI, total adipose tissue, visceral fat, ambulatory artery stiffness index and decreased FEV1. In turn, the corresponding predictors for patients with hypertension are an increase in total adipose tissue, ambulatory artery stiffness index and a decrease in muscle tissue. For the first time it was found that patients with comorbid pathology of hypertension and COPD have a prolonged effect of COPD, which leads to worsening of hypertension, increased vascular stiffness, increased serum cystatin C and impaired renal function with chronic kidney disease.
The peculiarities of the distribution of adipose and muscle tissue according to the results of bioimpedancemetry in patients with hypertension and COPD and the influence of nutritional status on renal function, hypertension and COPD were studied.
For the first time, the following predictors of decreased renal function (GFR < 60 ml/min) in patients with hypertension, COPD and combined hypertension and COPD, as separate indicators of nutritional status (content of total adipose tissue, muscle tissue, visceral fat, BMI), daily monitoring of blood pressure (ambulatory artery stiffness index, nocturnal SBP decrease rate and DBP rate increase) and pulmonary ventilation function (FEV1).
In order to improve the diagnosis of renal impairment in patients with a combination of hypertension, COPD and COPD, it is recommended to include determination of urinary albumin and creatinine, to calculate the albumin-creatinine ratio of urine and GFR for blood creatinine. Patients with hypertension are recommended to determine blood cystatin C as an early marker of renal disorders, to calculate GFR for cystatin C due to the greater informativeness of this method for this group of patients.
Patients with comorbid hypertension and COPD, and patients with hypertension and COPD should, in addition to anthropometric methods with BMI calculation, perform bioimpedancemetry to determine the total content of adipose, muscle and visceral fat. Patients with hypertension who have > 35.9 % adipose tissue and < 26.1 % muscle, should be transferred to a high risk group for CKD. In comorbid hypertension and COPD, the amount of adipose tissue > 41.3%, the amount of visceral fat > 11% and BMI > 30 kg/m2, respectively, needs to be corrected.
At carrying out DMAT of patients with hypertension with definition of an ambulatory index of rigidity of arteries > 0,36, indicators of speed of increase of DBP > 0,27 and night decrease of SAT > 8,1 and patients with comorbid hypertension and COPD with value of ambulatory index of rigidity of arteries > 0,43 considered patients at high risk of developing chronic kidney disease.
In patients with combined hypertension and COPD with FEV1 < 64% and in patients with COPD with FEV1 < 50% consider a high risk of decreased renal function.
