Renal Function and Cardiovascular Risk in Patients With Arterial Hypertension and Obesity: The Role of Leptin and Adiponektin

Abstract

THE AIM:to evaluate the role of laboratory obesity markers in the progression of chronic kidney disease (CKD) and the development of cardiovascular complications in patients with arterial hypertension (AH) and obesity.PATIENTS AND METHODS. 120 patients with AH stage II-III aged from 45 to 70 years with unachieved target blood pressure values (BP) were divided into four comparable in sex, age, frequency of smoking occurrence, hypertension duration, the level of office systolic AD (SBP) and diastolic blood pressure (DBP) groups depending on the body mass index (BMI). We performed physical examination, evaluated the renal function, laboratory markers of obesity, analyzed the combined risk of CKD progression and the development of cardiovascular complications.RESULTS.There was a significant increase in the level of proteinuria (PU) and albuminuria (AU) among the patients in groups 3 and 4 compared with group 1 (301.3 [138.1, 691.0] and 305.7 [139.4, 646.9] vs 101.3 [47.9, 116.9] mg/g; 91.0 [65.9, 273.5] and 119.2 [91.0, 291.2 vs 42.2 [41.3; 51.1] mg/g, respectively), as well as a statistically significant decrease in the glomerular filtration rate (GFR) in patients of groups 3 and 4 compared with patients in group 1 (63,53,73 and 61,22,71 vs 72 [ 64; 98] mL / min / 1.73 m2). Serum leptin concentration increased from group 1 to group 4 (significant differences were found between groups 2,3,4 in comparison with group 1 and between group 4 in comparison with group 2), while the concentration of adiponectin decreased from group 1 to group 4 (the differences were significant between groups 2,3,4 in comparison with group 1). A statistically significant inverse correlation between GFR and leptin concentration (r = -0.42), a direct correlation between the concentration of adiponectin and GFR (r = 0.36), the inverse relationship between the concentration of adiponectin and PU (r = -0.33), AU (r = -0.24) were found.CONCLUSION.The study showed a statistically significant progressive deterioration in the renal function, as well as an increase in the combined risk of progression of CKD and the development of cardiovascular complications in AH patients with an increase in obesity with comparable values of office SAP and office DAP among the studied groups. The revealed reliable correlation interrelations between the parameters of renal function and obesity markers testify to the important pathogenetic role of leptin and adiponectin in the development and progression of CKD in patients with AH and obesity.

The state of the main arteries, vascular age in patients with arterial hypertension and obesity: the role of leptin and adiponectin

“…Практическая значимость выявления высокого процента больных с абдоминальным ожирением в группе больных с избыточной массой тела и висцерального ожирения в группе лиц с нормальным и избыточным ИМТ заключается в необходимости оценки не только ИМТ при диагностике ожирения, но и значений ОТ, соотношения ОТ/ОБ, а также содержания висцерального жира в организме [10].…”

“…Один из патогенетических механизмов повышения жесткости магистральных артерий связан с выработкой метаболически активной жировой тканью гормонов и цитокинов, в т. ч. ангиотензиногена, ангиотензина II. Обсуждаются защитная роль адипонектина и негативная роль лептина в повреждении органов-мишеней, в том числе и крупных сосудов [10]. Полученные данные сопоставимы с результатами зарубежных коллег, которые указывают, что концентрация адипокинов в сыворотке может быть предиктором артериальной ригидности у пациентов с АГ [7,12].…”