Цель исследования. Анализ факторов, ассоциированных со снижением скорости клубочковой фильтрации (СКФ), у больных хронической обструктивной болезнью легких (ХОБЛ). Материалы и методы. В исследование включены 198 больных ХОБЛ 1–4-й степени тяжести (GOLD 2014), находившихся на обследовании и лечении в ГБУЗ «Краевая клиническая больница №2» г. Краснодара, контрольную группу составили 28 здоровых добровольцев, сопоставимых по возрасту и полу. Помимо общеклинических исследований, всем пациентам был проведен расчет СКФ по формуле СКD-EPI на основе сывороточного цистатина С (СКФцис). Вклад факторов в развитие хронической болезни почек (ХБП) определяли с помощью многофакторного линейного регрессионного анализа, в качестве зависимой переменной использовали величину СКФцис. Результаты и обсуждение. Обнаружено, что более половины (51,5%) пациентов с ХОБЛ имеют снижение СКФцис <60 мл/мин/1,73 м2, что является основанием для установления диагноза ХБП без учета лабораторных и инструментальных исследований. При проведении регрессионного анализа с прямым пошаговым включением отобранных переменных определены независимые факторы, ассоциированные со снижением СКФ у больных ХОБЛ: величина ОФВ1, SpO2, количество баллов по шкале mMRC, уровень СРБ, фибриногена, индекс курильщика. Выводы. Выявлена высокая частота ХБП у больных ХОБЛ (51,5%), а также корреляционная взаимосвязь между наличием дисфункции почек и тяжестью ХОБЛ. Подтверждено влияние клинико-диагностических параметров тяжести ХОБЛ на развитие дисфункции почек.
Ключевые слова: скорость клубочковой фильтрации, хроническая обструктивная болезнь легких, хроническая болезнь почек, коморбидность, системные эффекты хронической обструктивной болезни легких.
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Aim. Analysis of factors associated with reduced glomerular filtration rate (GFR) in patients with chronic obstructive pulmonary disease (COPD). Materials and methods. The study included 198 patients with COPD 1–4 degrees of severity (GOLD 2014), who were on examination and treatment in Krasnodar Regional clinical hospital № 2. The control group consisted of 28 healthy volunteers, comparable in age and sex. In addition to clinical research, all patients, we calculated GFR according to the formula СКD-EPI based on cystatin C serum (GFRcys). The contribution of the factors in the risk of developing CKD was determined using multivariate linear regression analysis, as dependent variable used the value of GFRcys. Results and discussion. It was found that more than half (51.5%) of patients with COPD have a decrease in GFRcys <60 ml/min/1.73 m2, which is the basis for the diagnosis of CKD without laboratory and instrumental studies. During the regression analysis with direct step-by-step inclusion of the selected variables, the independent factors associated with a decrease in GFR in COPD patients were determined: the value of FEV1, SpO2, the number of points on the mMRC scale, the level of C-reactive protein, fibrinogen, and the smoker index. Summary. The high incidence of CKD in patients with COPD (51.5%), as well as the correlation between the presence of renal dysfunction and the severity of COPD were revealed. The influence of clinical and diagnostic parameters of COPD severity on the development of renal dysfunction was confirmed.
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13. Kim YS, Kim HY, Ahn H-S, et al. Glomerular filtration rate affects interpretation of pulmonary function test in a Korean general population: results from the Korea National Health and Nutrition Examination Survey 2010 to 2012. Korean J Intern Med. 2016;31(6):1101-9. doi: 10.3904/kjim.2015.148
14. Ford ES. Urinary albumin-creatinine ratio, estimated glomerular filtration rate, and all-cause mortality among US adults with obstructive lung function. Chest. 2015;147(1):56-67. doi: 10.1378/chest.13-2482
15. Ying-Mei Feng, Thijs L, Zhen-Yu Zhang, Wen-Yi Yang, Qi-Fang Huang, Fang-Fei Wei, Kuznetsova T, Jennings A-M, Delles C, Lennox R, Verhamme P, Dominiczak A, Staessen JA. Glomerular function in relation to circulating adhesion molecules and inflammation markers in a general population. Nephrol Dial Transplant. 2018; 33(3):426-35. doi: 10.1093/ndt/gfx256
16. Kochi M, Kohagura K, Shiohira Y, Iseki K, Ohya Y. Inflammation as a Risk of Developing Chronic Kidney Disease in Rheumatoid Arthritis. Aguilera AI, ed. PLoS ONE. 2016;11(8):e0160225. doi: 10.1371/journal.pone.0160225
17. Barakat M, McDonald H, Collier T, et al. Acute kidney injury in stable COPD and at exacerbation. Int J Chron Obstruct Pulm Dis. 2015;10:2067-77. doi: 10.2147/COPD.S88759
18. Kirkman DL, Muth BJ, Ramick MG, Townsend RR, Edwards DG. The role of mitochondria derived reactive oxygen species in microvascular dysfunction in chronic kidney disease. Am J Physiol Renal Physiol. Published 8 Nov. 2017;314(3):F423–F429. doi: 10.1152/ajprenal.00321.2017
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1. Сlinical practice guidelines by KDIGO 2012 to the diagnosis and treatment of chronic kidney disease. Nefrologiya i Dializ. 2017;19(1):22-206 (In Russ.)
2. From the Global Strategy for the Diagnosis, Management and Prevention of COPD, Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2017. Ссылка активна на 20.11.2017. http://goldcopd.org/gold-2017-global-strategy-diagnosis-management-prevention-copd/
3. Bolotova EV, Dudnikova AV. Chronic kidney disease in patients with chronic obstructive pulmonary disease: a role of exacerbations. Pul'monologiya. 2016;25(5):578-83 (In Russ.) doi: 10.18093/0869-0189-2016-26-5-578-583
4. Gaddam S, Gunukula SK, Lohr JW, Arora P. Prevalence of chronic kidney disease in patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis. BMC Pulmon Med. 2016;16:158. doi: 10.1186/s12890-016-0315-0
5. Samoni S, Husain-Syed F, De Rosa S, Ronco C. Cardio-Pulmonary-Renal interactions. Review. G Ital. Nefrol. 2017;34 Suppl 69:162-77.
6. Chen C-Y, Liao K-M. Chronic Obstructive Pulmonary Disease is associated with risk of Chronic Kidney Disease: A Nationwide Case-Cohort Study. Sci Rep. 2016;6:25855. doi: 10.1038/srep25855
7. Bolotova EV, Dudnikova AV. Particular risk factors for chronic kidney disease in patients with chronic obstructive pulmonary disease. Nefrologiya. 2015;5(19):28-33 (In Russ.) https://elibrary.ru/download/ elibrary_24344512_70758187.pdf
8. Report GOLD: Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. Ссылка активна на 20.11.2017. http://goldcopd.org/wpcontent/uploads/2016/04/ GOLD_Report_Russian_2014.pdf
9. Federal clinical guidelines for the diagnosis and treatment of COPD. Russian Respiratory Society. 2016. Available from: http://spulmo.ru/obrazovatelnye-resursy/federalnye-klinicheskie-rekomendatsii/?clear_cache=Y (In Russ.)
10. Yoshizawa T, Okada K, Furuichi S, Ishiguro T, Yoshizawa A, Akahoshi T, Gon Y, Akashiba T, Hosokawa Y, Hashimoto S. Prevalence of chronic kidney diseases in patients with chronic obstructive pulmonary disease: assessment based on glomerular filtration rate estimated from creatinine and cystatin C levels. Int J Chron Obstruct Pulmon Dis. 2015;10:1283-9. doi: 10.2147/copd.s80673
11. Bolotova EV, Dudnikova AV, Yavlyanskaya VV. Features of renal dysfunction in patients with chronic obstructive pulmonary disease. Klinicheskaya Nefrologiya. 2017;(1):18-22 (In Russ.) https://www.nephrologyjournal.ru/ru/archive/article/34433
12. Nagajceva SS, Shvecov MYu, Lukshina LP, et al. For the first time revealed the chronic kidney disease among patients of a therapeutic Department: the role of the method of calculation of GFR by CKD-EPI. Klinicheskaya Medicina. 2015;(7):56-61 (In Russ.)
13. Kim YS, Kim HY, Ahn H-S, et al. Glomerular filtration rate affects interpretation of pulmonary function test in a Korean general population: results from the Korea National Health and Nutrition Examination Survey 2010 to 2012. Korean J Intern Med. 2016;31(6):1101-9. doi: 10.3904/kjim.2015.148
14. Ford ES. Urinary albumin-creatinine ratio, estimated glomerular filtration rate, and all-cause mortality among US adults with obstructive lung function. Chest. 2015;147(1):56-67. doi: 10.1378/chest.13-2482
15. Ying-Mei Feng, Thijs L, Zhen-Yu Zhang, Wen-Yi Yang, Qi-Fang Huang, Fang-Fei Wei, Kuznetsova T, Jennings A-M, Delles C, Lennox R, Verhamme P, Dominiczak A, Staessen JA. Glomerular function in relation to circulating adhesion molecules and inflammation markers in a general population. Nephrol Dial Transplant. 2018; 33(3):426-35. doi: 10.1093/ndt/gfx256
16. Kochi M, Kohagura K, Shiohira Y, Iseki K, Ohya Y. Inflammation as a Risk of Developing Chronic Kidney Disease in Rheumatoid Arthritis. Aguilera AI, ed. PLoS ONE. 2016;11(8):e0160225. doi: 10.1371/journal.pone.0160225
17. Barakat M, McDonald H, Collier T, et al. Acute kidney injury in stable COPD and at exacerbation. Int J Chron Obstruct Pulm Dis. 2015;10:2067-77. doi: 10.2147/COPD.S88759
18. Kirkman DL, Muth BJ, Ramick MG, Townsend RR, Edwards DG. The role of mitochondria derived reactive oxygen species in microvascular dysfunction in chronic kidney disease. Am J Physiol Renal Physiol. Published 8 Nov. 2017;314(3):F423–F429. doi: 10.1152/ajprenal.00321.2017
Авторы
Е.В. Болотова, А.В. Дудникова
ФГБОУ ВО «Кубанский государственный медицинский университет» Минздрава России, Краснодар, Россия