Markers of chronic kidney disease and disorders of renal hemodynamics in patients with medically-controlled arterial hypertension and high and very high cardiovascular risk

Aim. To determine the frequency of markers of chronic kidney disease (CKD) in hypertensive patients with high and very high cardiovascular risk, to assess relationship with the renal hemodynamics.

Material and methods. We studied 70 patients with medically-controlled hypertension (63,2±8,3 years, 48,6% male, office blood pressure (BP) was 130,5±13,7/78,1±8,5 mm Hg), 40 patients from them as part the Russian multicenter program CHRONOGRAF. Measurement of the office BP, ambulatory BP monitoring were performed. Glomerular filtration rate (GFR) was calculated using the CKD-EPI formula, and albuminuria (AU) was determined as albumin/creatinine (A/Cr) ratio in the morning portion of urine (n=40) or 24-hour urinary albumin excretion (UAE) (n=22). Intrarenal vascular resistance was estimated by renal duplex Doppler ultrasound, the resistive index (RI) levels were calculated.

Results. GFR and albuminuria were normal in 68,6% of patients with well-medically-controlled hypertension: achieved levels of office BP, BP-day and BP-night were established. Markers of CKD were detected in 31,4% of patients (GFR <60 ml/ min/1,73 m2 in 271% patients, A/Cr >30 mg/g and/or UAE >30 mg/day in 12,9%). RI in the segmental intrarenal arteries was correlated with GFR (Rs=-0,4232, p=0,0005). The levels of renal RI were higher in CKD-patients vs non-CKD-patients and those were the highest in diabetic patients. The impact of the RI values in segmental IRA to the detection of CKD markers was established during the ROC-analysis.

Conclusion. The high frequency of markers of CKD (31,4%) was identified even in patients with well-medically-controlled hypertension. The negative correlation was between GFR and RI. There were expressed disturbances of renal hemodynamics in the presence of CKD markers, especially in patients with DM2. The cut-off point RI in segmental IRA to the identification of markers of CKD is 0,725.

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