Hippokratia 2004, 8(2):78-80
A Lubomirova, E Andreev, M Stoyanova, N Stoyanova, A, Tzontcheva, R Djerassi, B Kiperova
Nephrology Clinic, University Hospital “Alexandrovska”, Sofia, Bulgaria
Cardiology Clinic, University Hospital “Alexandrovska”, Sofia, Bulgaria
Clinical Laboratory Dpt, University Hospital “Alexandrovska”, Sofia, Bulgaria
Background: Cardiovascular morbidity and mortality in patients with chronic renal failure (CRF) is higher than in general population. The consideration that this patients are a ” higher risk” group for subsequent cardiovascular disease events is based on detection of multiple cardiovascular risk factors- “traditional” and unique for chronic renal failure.
Material and Methods: We evaluated cardiovascular risk factors (CVF) in patients with CRF and followed them for a 9 month period for clinical presentation of cardiovascular disease.
Seventeen pts were examined -10 F and 7 M, average age 49 years with glomerular filtration rate from 10 to 58 ml/min. Four pts were with primary glomerulonephritis (GN), 4- secondary GN, 2- I type diabetes, 1 -II type diabetes, 2 -chronic pyelonephritis, 2 with hypertensive nephropathy and 3 others – with interstitial nephritis, amyloidosis and Balkan endemic nephropathy each. Elevated blood pressure was detected in all pts. Immunosuppressive therapy was needed in 2 pts with GN.
We examined “traditional” CVF (age, gender, body mass index, smoke, blood pressure, hyperlipidemia, carbohydrate metabolism- diabetes or glucose intolerance) as well as related to CRF CVF (anemia, hyperphosphatemia, left ventricular hypertrophy, hyperhomocysteinemia, hyperinsulinemia, based on the values of IRI, proteinuria and need for pathogenic treatment with steroids.
Results: After 9 month period 7 pts (35%) had coronary incident: 1 -died from myocardial infarction; in 2-ischemic heart disease was manifested by arrhythmia; in other 3-ECG criteria for heart ischemia was detected. All of these patients had moderate or advanced renal failure, diabetes or hyperinsulinemia and were positive for all related to CFR CVF.
Conclusion: In patients with chronic renal disease a straight forward search and correction of the classical and uremia-related cardiovascular risk factors are necessary even at the earliest stages. Primary and secondary prevention of all risk factors will decrease the serious cardiovascular complications in patints with chronic renal failure and will prolong and better their lives.