THE PREVALENCE OF CHRONIC KIDNEY DISEASE MARKERS IN ARTERIAL HYPERTENSION PATIENTS AND RELATION WITH DIABETES: RESULTS OF EPIDEMIOLOGICAL STUDY KHRONOGRAPH

Aim. Under the framework of non-interventional observational multi-center program KHRONOGRAPH (Acquisition of additional data on the prevalence of declined glomerular filtration rate and albuminuria in systemic hypertension patients with and with no diabetes mellitus type 2 in Russian Federation) to evaluate the prevalence of chronic kidney disease (CKD) markers.

Material and methods. In 1363 patients with arterial hypertension (AH) and/or type 2 diabetes (DM2) the glomerular filtration rate (GFR) was calculated with CKD-EPI, and albuminuria (AU) assessed via albumin/creatinine ratio (ACr) in morning urine.

Results. In DM2 patients (n=779, 62,6% women, 63,8 y. o.) comparing to non-DM2 patients (n=584, 50,7% women, 60,5 y. o.) there was more common decrease of GFR <60 mL/min/1,73 m² (38 and 31%), <45 mL/min/1,73 m² (G3b-G5) (15,92 and 9,94%) and <30 mL/min/1,73 m² (G4-G5) (4,24 and 2,06%), high and very high AU (36,6 and 28,1%), very high AU (А3) — (7,32 and 2,40%). In DM2 patients there was more common presence of at least one marker of CKD <60 mL/min/1,73 m² and/or ACr >30 mg/g) (54,0 and 44,35%), isolated GFR decrease <60 mL/min/1,73 m² (17,46 and 16,27%), isolated increase of ACr >30 mg/g (15,66 and 13,35%) and combination of decreased GFR and high/very high AU (20,93 and 14,71%). Among DM2 patients, the portion is lower of decreased combination risk of CKD progression and cardiovascular complications (45,2 and 53,6%), higher — in very high risk (28,5 and 20%). Most prevalent are the combinations related to early stages of CKD: G3аА1, G2А2 and G3аА2.

Conclusion. In Russian Federation, patients with AH, regardless of DM2, are characterized by high rate of CKD markers. In DM2 patients comparing to those with none, there was more prevalent GFR decrease <60 mL/min/1,73 m², increase of ACr >30 mg/g isolated and in combination. In AH and DM2 the portion of patients with a very high risk of CKD progression and cardiovascular complications is higher.

1. Coresh J. Update on the Burden of CKD. J Am Soc Nephrol 2017; 28. DOI: 10.1681/ASN.2016121374.

2. Dedov II, Shestakova MV, Mayorov AY, et al. Clinical Guidelines “Algorithms of specialized medical care for diabetes mellitus patients”. Edited by Dedov II, Shestakova MV (8th edition). Diabetes mellitus. 2017; 20 (1S): 1-112. (In Russ.) Дедов И. И., Шестакова М. В., Майоров А. Ю. и др. Клинические рекомендации “Алгоритмы специализированной медицинской помощи больным сахарным диабетом”. 8-й выпуск. Под редакцией И. И. Дедова, М. В. Шестаковой, А. Ю. Майорова. Сахарный диабет. 2017; 20 (1S): 1-112. DOI: 10.14341/DM20171S8.

3. Tomilina NA, Bikbov BT. Renal replacement therapy for end-stage renal disease patients in Russian Federation, 1998-2011 (Report of the Russian Registry of Renal Replacement Therapy). Russian Journal of Transplantology and Artificial Organs. 2015; 17 (1): 35-58. (In Russ.) Томилина Н. А., Бикбов Б. Т. Состояние заместительной почечной терапии при хронической почечной недостаточности в России в 1998-2011 гг. (по данным регистра Российского диализного общества). Вестник трансплантологии и искусственных органов. 2015; 17 (1): 35-58. DOI: 10.15825/1995-1191-2015-1-35-58.

4. Maslova OV, Suntsov YV, Shestakova MV, et al. Prevalence of diabetic nephropathy in Russian Federation. Klinicheskaya nefrologiya. 2010; 3: 45-50. (In Russ.) Маслова О. В., Сунцов Ю. И., Шестакова М. В., и др. Распространенность диабетической нефропатии и хронической болезни почек при сахарном диабете в Российской Федерации. Клиническая нефрология. 2010; 3: 45-50.

5. National Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis 2002; 39 (suppl 1): S1–266. DOI: CliCa0405689692.

6. KDIGO 2012 Clinical Practice Guidelines for the Evaluation and Management of Chronic Kidney Disease. http://www.kdigo.org/clinical_practice_guidelines/pdf/CKD/KDIGO_2012_CKD_GL.pdf. DOI: 10.1007/s11255-014-0761-7.

7. Smirnov AV, Shilov EM, Dobronravov VA, et al. National guidelines. Chronic kidney disease: basic principles of screening, diagnosis, prevention and treatment approaches. Nephrology 2012; 16 (1): 89-115 (in Russ.) Смирнов А. В., Шилов Е. М., Добронравов В. А. и др. Национальные рекомендации. Хроническая болезнь почек: основные принципы скрининга, диагностики, профилактики и подходы к лечению. Нефрология 2012; 16 (1): 89-115.

8. Moiseev VS, Mukhin NA, Smirnov AV, et al. Clinical guidelines. Cardiovascular risk and chronic kidney disease: cardionephroprotection. Russian Journal of Cardiology. 2014; 8 (112): 7-37. (in Russ.) Моисеев В. С., Мухин Н. А., Смирнов А. В. и др. Национальные рекомендации: Сердечно-сосудистый риск и хроническая болезнь почек: стратегии кардионефропротекции. Российский кардиологический журнал 2014; 8 (112): 7-37. DOI: 10.15829/1560-4071-2014-8-7-37.

9. Go AS, Chertow GM, Fan D, et al. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med 2004; 351: 1296-305. DOI: 10.1056/NEJMoa041031.

10. Matsushita K, van der Velde M, Astor BC, et al. Chronic Kidney Disease Prognosis Consortium. Association of estimated glomerular filtration rate and albuminuria with allcause and cardiovascular mortality in general population cohorts: a collaborative metaanalysis. Lancet. 2010; 375 (9731): 2073-81. DOI: 10.1016/S0140-6736(10)60674-5.

11. Catapano AL, Graham I, De Backer G, et al. 2016 ESC/EAS Guidelines for the management of dyslipidaemias. Russian Journal of Cardiology. 2017;(5):7-77. (In Russ.) Catapano AL, Graham I, De Backer G, et al. Рекомендации ЕОК/ЕОА по диагностике и лечению дислипидемий 2016. Российский кардиологический журнал. 2017; 5 (145): 7-77. DOI: 10.15829/1560-4071-2017-5-7-77

12. Oshchepkova EV, Dolgusheva IA, Zhernakova IV, et al. The prevalence of renal dysfunction in arterial hypertension (in the framework of the ESSE-RF study). Systemic Hypertension. 2015; 12 (3): 19-24. (In Russ.) Ощепкова Е. В., Долгушева Ю. А., Жернакова Ю. В. и др. Распространенность нарушения функции почек при артериальной гипертонии (по данным эпидемиологического исследования ЭССЕ-РФ). Системные гипертензии. 2015; 12 (3): 19-24.

13. Nagaytseva SS, Shvetsov MY, Shalyagin YD, et al. Risk factors for increase of albuminuria as an early marker of chronic kidney disease in different age groups. Nephrology 2013; 4: 58-62. (in Russ.) Нагайцева С. С., Швецов М. Ю., Шалягин Ю. Д. и др. Факторы риска повышения альбуминурии как раннего маркера хронической болезни почек в разных возрастных группах. Нефрология. 2013; 4: 58-62. DOI: 10.18786/2072-05052014-30-37-45.

14. Nagaytseva SS, Shvetsov MY, Gerasimov AN, et al. Assessment of albuminuria as a marker of chronic kidney disease in adult working population. Almanac of Clinical Medicine. 2014; 30: 37-45. (In Russ.) Нагайцева С. С., Швецов М. Ю., Герасимов А. Н. и др. Исследование альбуминурии как маркера хронической болезни почек у взрослого трудоспособного населения. Альманах клинической медицины. 2014; 30: 37-45. DOI: 10.18786/2072-0505-2014-30-37-45.

15. https://www.usrds.org/adrhighlights.aspx 2017 Annual Data Report Highlights

16. Ene-Iordache B, Perico N, Bikbov B, et al. Chronic kidney disease and cardiovascular risk in six regions of the world (ISN-KDDC): a cross-sectional study. Lancet Glob Health 2016; 4: e307-19. DOI: 10.1016/S2214-109X(16)00071-1.

17. Wu B, Bell K, Stanford A, et al. Understanding CKD among patients with T2DM: prevalence, temporal trends, and treatment patterns–NHANES 2007–2012. BMJ Open Diabetes Res Care. 2016; 4 (1): e000154. DOI: 10.1136/bmjdrc-2015-000154.

18. Antonova TN, Bikbov BT, Gal IG, Tomilina NA. On the prevalence of chronic kidney disease among elderly people in Moscow and its connection with cardiovascular pathology. Nefrologiya i dializ. 2011; 13 (3): 353-4. (in Russ.) Антонова Т. Н., Бикбов Б. Т., Галь И. Г., Томилина Н. А. К вопросу о распространенности хронической болезни почек среди пожилых лиц в г. Москве и ее связи с сердечно-сосудистой патологией. Нефрология и диализ. 2011; 13 (3): 353-4.

19. Tuttle KR, Stein JH, DeFronzo RA. The natural history of diabetic nephropathy. Semin Nephrol. 1990; 10 (3): 184-93.

20. Martínez-Castelao A, Navarro-González JF, Górriz JL, de Alvaro F. The concept and the epidemiology of diabetic nephropathy have changed in recent years. J Clin Med. 2015; 4 (6): 1207-16. DOI: 10.3390/jcm4061207.

21. Zeni L, Norden AGW, Cancarini G, Unwin RJ. A more tubulocentric view of diabetic kidney disease. J Nephrol. 2017; 30 (6): 701-17. DOI: 10.1007/s40620-017-0423-9.

22. Perkins BA, Ficociello LH, Roshan B, et al. In patients with type 1 diabetes and new-onset microalbuminuria, the development of advanced chronic kidney disease may not require progression to proteinuria. Kidney Int. 2010; 77 (1): 57-64. DOI: 10.1038/ki.2009.399.

23. Thomas MC, Macisaac RJ, Jerums G, et al. Nonalbuminuric renal impairment in type 2 diabetic patients and in the general population (National Evaluation of the Frequency of Renal Impairment Co-existing with NIDDM [NEFRON] 11). Diabetes Care. 2009; 32 (8): 1497-502. DOI: 10.2337/dc08-2186.

24. Shamkhalova MSh, Trubitsina NP, Zaytseva NV, Shestakova MV. Features of renal pathology in patients with type 2 diabetes mellitus. Difficult Patient. 2006; 8: 73-6. (in Russ.) Шамхалова М. Ш., Трубицына Н. П., Зайцева Н. В., Шестакова М. В. Особенности почечной патологии у больных сахарным диабетом 2 типа. Трудный пациент. 2006; 8: 73-6.

25. Afkarian M, Zelnick LR, Hall YN, et al. Clinical manifestations of kidney disease among US adults with diabetes, 1988–2014. JAMA. 2016; 316 (6): 602-10. DOI: 10.1001/jama.2016.10924.

26. American Diabetes Association. Standards of medical care in diabetes — 2017. Diabetes Care 2017; 40 (Suppl 1): S1-135. DOI: 10.2337/dc17-S003.

27. Brück K, Jager KJ, Dounousi E, et al. Methodology used in studies reporting chronic kidney disease prevalence: a systematic literature review. Nephrol Dial Transplant 2015; 30 (Suppl 4): iv6-16. DOI: 10.1093/ndt/gfv131.