Influence of viscersal obesity and adipokin status on the rsenal function in hyperstensive patients with obesity and chrsonic hearst failurse

Abstract

THE AIM: to evaluate the effect of visceral obesity, adipokine status on the functional state of the kidneys in patients with arterial hypertension (AH), obesity, and chronic heart failure (CHF).PATIENTS AND METHODS. 383 AH patients aged 45-70 years were divided into four groups: group 1 - persons with AH without obesity and CHF, group 2 - AH + obesity without CHF, group 3 - AH + obesity + CHF, group 4 - AH + CHF without obesity. A clinical examination was carried out, the indicators of visceral obesity, adipokine status, and functional state of the kidneys were assessed. In addition to descriptive statistics, comparison of groups with each other, and correlation analysis, multivariate regression analysis was used with the construction of regression equations.RESULTS. Revealed statistically significant differences between 1 and 2, 1 and 3, 2 and 4, 3 and 4 groups not only in body mass index (BMI) - 23.9 [22.4; 24.3] vs 32.8 [31.1; 36.3], 23.9 [22.4; 24.3] vs 33.6 [30.8; 35.6], 32.8 [31.1; 36.3] vs 24.1 [23.1; 24.5], 33.6 [30.8; 35.6] vs 24.1 [23.1; 24.5] kg / m2, respectively, but also by the percentage of visceral fat (7.0 [6.0; 8.0] vs 14.0 [11.0; 16.0] vs 18.0 [14.3; 22.0] vs 8.0 [5.0; 10.0] % in groups 1,2, 3 and 4, respectively - p1-2, p1-3, p2-3, p2-4, p3-4 less than 0,0001, p1-4 = 0.022. The level of leptin in blood serum was significantly lower in group 1 in comparison with 2, 3, 4, and in group 4 in comparison with 3 (6.9 [6.6; 22.7] vs 64.8 [59.3; 70.3], 63.6 [42.0; 86.1], 58.7 [18.9; 73.5] and 58.7 [18.9; 73, 5] vs 63.6 [42.0; 86.1] ng / ml, respectively) The serum adiponectin concentration was statistically significantly higher in group 1 compared with group 2, 3 and in group 4 compared with group 3 (36.6 [29.2; 44.1] vs 18.9 [17.1; 20.6] vs 26.9 [22.2; 32.2] and 36.8 [20.2; 62.8] vs 26,9 [22.2; 32.2] ng / ml, respectively) Visceral obesity index (VAI) was 1.49 [1.24; 2.07] vs 2.58 [2.03; 3.37] vs 3.08 [2.59; 3.84] vs 2.36 [1.81; 3.13] c.u. in groups 1,2, 3, 4, respectively, p1-2 = 0.0007, p1 -4 = 0.0001, p2-3 = 0.017, p1-3 and p3-4 less than 0.00001. There was a significant decrease in the glomerular filtration rate (GFR) in groups 3 and 4 in comparison with group 1 (59.0 [53.0; 67.8] and 69.0 [62.0; 83.0] vs 75.0 [68.0; 96.0] ml / min / 1.73 m2, respectively), as well as in group 3 in comparison with 2 and 4 (59.0 [53.0; 67.8] vs 71.0 [60.0; 86, 5] and 69.0 [62.0; 83.0] ml / min / 1.73 m2, respectively). The level of albuminuria increased with adherence to hypertension of obesity and / or CHF (14.2 [3.7; 44.4] vs 36.9 [13.6; 118.2] vs 149.8 [92.2; 247, 6] vs 72.0 [36.2; 104.7] mg / g in groups 1,2, 3 and 4, respectively, the differences are statistically significant between 1 and 2, 1 and 3, 1 and 4, 2 and 3, 3 and 4 groups). The concentration of p2-microglobulins in urine was significantly lower in group 1 compared with groups 3 and 4 (0.10 [0.05; 0.42] vs 0.25 [0.20; 0.31] vs 0.27 [0,19; 0.31] pg / ml). Correlation analysis revealed the peculiarities of the influence of visceral obesity, adipokine status on the functional state of the kidneys in each of the studied groups.CONCLUSION. The study confirmed the negative effect of visceral obesity, hyperleptinemia, and hypoadiponectinemia on the progressive deterioration of the renal function in hypertensive patients with adherence to obesity and/or CHF.