Gender features of cardiorenal relationships and cytokine status in patients with chronic kidney disease
I.T. Murkamilov, K.A. Aitbaev, V.V. Fomin
1) Kyrgyz State Medical Academy n.a. I.K. Akhunbaev, Bishkek, Kyrgyzstan;
2) Kyrgyz-Russian Slavic University n.a. the First President of the Russian Federation B.N. Yeltsin, Bishkek, Kyrgyzstan;
3) Scientific Research Institute of Molecular Biology and Medicine, Bishkek, Kyrgyzstan;
4) FSBEI HE ''I.M. Sechenov First Moscow State Medical University'', Moscow, Russia
Objective. Evaluation of cardiovascular disorders and cytokine status, and their relationship with the glomerular filtration rate in men and women at the predialysis stage of chronic kidney disease (CKD).
Material and methods. 170 patients aged 19 to 86 years who had CKD with high and very high (additional) cardiovascular risk were examined. The mean age of the examined patients was 56.2±13.9 years. CKD was diagnosed in accordance with the recommendations of the Russian Scientific Society of Nephrology. The serium interleukin-6 (IL-6), IL-10 levels were evaluated. Glomerular filtration rate (GFR) was calculated by the method of F.J. Hoek et al., proposed in 2003 (80.35/CystatinS-4.32=GFR). All patients underwent ultrasound examination of the heart and blood vessels, and central arterial pressure was measured. The patients were randomized into two age-, anthropometric- and hemodynamic parameter-matched groups: 1st (n=77) female, and 2nd (n=93) male.
Results. A decrease in GFR less than 60 ml/min/1.73 m2 was detected in 49.4% of the examined patients. In the male group, C4-stage CKD was significantly more frequently recorded. The diameter of the left ventricular outflow tract (3.31±0.35 versus 3.11±0.40 cm; p<0.05), the carotid intima-media thickness (carotid IMT) (1.12 against 0.97 mm; p<0.05), left atrial size (3.98±0.57 versus 3.75±0.59 cm; p<0.05), left ventricle (LV) end-diastolic diameter (5.24±0, 66 vs 4.97±0.43 cm; p<0.05), the interventricular septum thickness (0.983±0.179 vs 0.925±0.180 cm; P<0.05), and LV mass (200.51±70.50 g versus 171.18±57.87 g; p <0.05) were significantly higher, and the LV ejection fraction (52.47±12.36 versus 58.28±5.79%; p<0.05), on the contrary, significantly lower in male group compared with female group. Concentric hypertrophy was significantly more common in men compared with women [16 (48.5%) versus 10 (33.3%); p<0.05], as well as concentric LV remodeling [12 (12.9%) versus 4 (5.1%); p<0.05]. At the same time, the number of patients with eccentric LV hypertrophy was significantly higher in women than in men [20 (66.7%) versus 17 (51.5%); p<0.05]. The values of the median and interquartile range of IL-10 [6,122 (2,381–7,204) versus 4,167 (1,761–7,500) pg/ml; p<0.05], the blood cystatin C and creatinine levels were significantly higher, and the GFR was lower in men compared with women. In men, a close relationship between the GFR and the central arterial pressure (r=-0.364; p=0.001) and the carotid IMT (r=-0.342; p=0.001) was also observed. At the same time, significant correlation between GFR and the serum IL-10 level was noted in the female group (r=-0.243; p=0.023).
Conclusion. In male CKD patients, changes in the cytokine status and cardiorenal relationships were more pronounced compared to females.
Keywords: chronic kidney disease, cardiovascular diseases, glomerular filtration rate, cytokines
About the Autors
Murkamilov I.T. – PhD in Medical Sciences, Nephrologist, Deputy Associate Professor at the Department of Faculty Therapy, I.K. Akhunbaev KSMA; Kyrgyz-Russian Slavic University n.a. the First President of Russia B.N. Yeltsin; Bishkek, Kyrgyzstan.
Aitbaev K.A. – Doctor of Medical Sciences, Professor, Head of the Laboratory of Pathological Physiology, Research Institute of Molecular Biology and Medicine at the NCCT of the Ministry of Health of the Kyrgyz Republic; Bishkek, Kyrgyzstan.
Fomin V.V. – Doctor of Medical Sciences, Professor, Corresponding Member of the Russian Academy of Sciences, Vice-Rector for Clinical Work and Postgraduate Professional Education, Director of the V.N. Vinogradov Faculty Therapy Clinic, Head of the Faculty Therapy Department № 1, Sechenov First MSMU; Moscow, Russia.