An analysis of the course of chronic kidney disease (CKD) and structural modification of the left ventricle (LV) at the pre-dialysis stage of the disease is presented.
Objective. Analysis of the features of the course of CKD and LV geometry at the predialysis stage, taking into account gender differences.
Material and methods. An open prospective study included 120 CKD patients at the predialysis stage. The mean age of the examined patients was 37.4±13.2 years, and the mean follow-up period was 14 months. Patients with CKD not receiving hemodialysis were selected for follow-up. All individuals signed informed consent for therapy and follow-up. Taking into account gender differences, all examined patients were divided into 2 age-matched groups: 52 women and 68 men. Along with a general clinical examination, all patients underwent echocardiography (EchoCG) at baseline and during follow-up. Glomerular filtration rate (GFR) was calculated using the CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) formula. During the study period, all patients were contacted through communication and semi-quarterly medical examinations, to which patients were invited to the clinic.
Results. At baseline, women and men did not differ significantly in age, anthropometric parameters, hemodynamics, lipid profile, electrolyte content, blood fibrinogen, daily proteinuria and GFR. The Hb level and the number of peripheral blood erythrocytes were significantly lower in women. At the same time, in the group of men, the total serum protein level was significantly lower, and creatinine – higher than in the group of women. The proportion of patients on glucocorticoid therapy was significantly higher among men (50.0 and 34.6%; p<0.05). In addition, echoCG indicators - linear dimensions of the left atrium (LA, cm), end-systolic (ESD) and diastolic dimensions (EDD) of the left ventricle (LV) - were significantly higher in men compared to women. There were no differences in the incidence of left ventricle hypertrophy (LVH) between the study groups. Initially, eccentric type LVH was the predominant type of remodeling in women (82.4%), and concentric type – in men (53.8%). During the follow-up, compared with baseline data the following indicators significantly decreased in women; erythrocyte sedimentation rate (ESR) – 15.0 (8.0;27.0) and 20.0 (10.0;33.5) mm/hour (p<0.05), fibrinogen concentration – 6.104 (4.107;6.771) and 6.216 (4.884;8.880) g/l (p<0.05), calcium level – 1.08±0.21 and 1.33±0.51 mmol/l (p <0.05) and daily proteinuria values – 2.299 (1.619;3.936) and 3.645 (1.968;6.623) g (p<0.05). At the same time, the albumin – 31.9±10.7 g/l and 27.1±10.3 g/l (p<0.05) and serum creatinine levels increased. In the group of men, there was a tendency towards a decrease in Hb level and the value of daily proteinuria, and also a significant decrease in ESR rates – 8.0 (4.0;21.0) and 16.0 (7.5;32.5) mm/hour (p<0.05) and blood triglyceride (TG) levels – 1.81 (1.18;2.36) versus 2.48 (1.75;3.43) mmol/l (p<0.05). In addition, there was a significant increase in the blood serum albumin and total protein levels. The proportion of patients with elevated C-reactive protein (CRP) levels also decreased: 8 (11.7%) and 15 (22.0%) (p <0.05) and there was an increase in creatinine concentration: 115.5 (86.5; 259.0) and 114.0 (83.5;174.0) µmol/l (p<0.05), decrease in estimated GFR – 66.2 (38.6;103.8) versus 84.9 ( 55.2;110.0) ml/min (p<0.05) and serum calcium levels – 1.16±0.36 and 1.49±0.52 mmol/l (p<0.05). A comparative analysis of the studied parameters between women and men in the dynamics of the study revealed the following. In the group of men, ESR indicators – 8.0 (4.0;21.0) and 15.0 (8.0;27.0) mm/hour (p<0.05), and blood TG concentrations – 1.81 (1.18;2.36) and 2.20 (1.64;3.24) mmol/l (p<0.05), were significantly lower, and the mean sodium and median serum creatinine levels were higher compared to those in women. In women, the number of peripheral blood red blood cells was also significantly lower. During the follow-up, the LV size turned out to be significantly higher in men compared to women: 3.40±0.49 cm and 3.22±0.35 cm (p<0.05), and concentric LV remodeling developed in 11.5% of women, which was not observed in the group of men. In women, by the end of the study, the interventricular septum (IVS) thickness significantly increased: 0.94±0.21 cm and 0.90±0.20 cm (p<0.05) compared to the initial value. Similar shifts in the IVS thickness were typical for men: 0.96±0.16 and 0.92±0.13 cm (p<0.05). In the group of women, a close direct relationship between the LV myocardial mass index (LVMI) and the systolic blood pressure – BP (r=0.676; p=0.005), diastolic blood pressure (r=0.651; p=0.005) and daily proteinuria (r=0.317; p=0.043), and an inverse relationship with estimated GFR (r=-0.410; p=0.008) were revealed Similar correlation shifts were also observed between LVMI and clinical and laboratory parameters in men, with the exception of daily proteinuria (r=0.082; p=0.506).
Conclusion. During the follow-up period, the indicators of ESR, fibrinogen concentration, blood calcium and the value of daily proteinuria significantly decreased in women, which was accompanied by an increase in the blood serum albumin and creatinine levels. In men, by the end of the follow-up period, there was a significant decrease in ESR and TG levels with a simultaneous increase in the blood serum albumin and total protein levels. The proportion of patients with elevated CRP levels decreased, and there was also a tendency towards a decrease in blood Hb concentration and the value of daily proteinuria. In addition, over the course of the study, the serum creatinine levels in men increased, which was accompanied by a decrease in the estimated GFR. Comparative analysis of data between groups revealed that ESR and blood TG levels in men turned out to be significantly lower, and the mean sodium and median serum creatinine levels were significantly higher compared to women. According to the echocardiography data during follow-up, LV ESR was significantly higher in men compared to women. During the follow-up period, both women and men had a significant increase in IVS thickness compared with the initial indicators. 11.5% of women developed concentric LV remodeling. In both groups, there was a statistically significant direct relationship between the LVMI and systolic and diastolic blood pressure, and an inverse relationship with the estimated GFR.

Keywords: gender differences, glomerular filtration rate, chronic kidney disease, left ventricular hypertrophy