Prevalence and severity of chronic kidney disease in a therapeutic hospital in patients with hypertension, angina pectoris, and type 2 diabetes mellitus: real practice of treating

Relevance. Chronic kidney disease (CKD) develops in the context of many diseases and has a progressive course, with the outcome of chronic renal failure.

Objective. To study the prevalence and severity of CKD in patients of the therapeutic department with hypertension, coronary heart disease (CHD) by type of angina 2-3 FC (NYHA), type 2 diabetes mellitus (T2DM) and their combinations, as well as the real practice of therapy of such patients.

Materials and methods. A total of 193 patients (average age 64.0 ± 18.1 with hypertension, CHD, T2DM, and their combinations were examined and treated in the therapeutic department of the N.A. Semashko City Hospital in the Yaroslavl Region was closed due to deterioration of their condition. The glomerular filtration rate (GFR) was calculated using the CKD-EPI formula. Statistical processing of the results was performed using the Statistica 12.0 program (StatSoft. Inc., USA).

Results. CKD stage 1 was diagnosed in 4.3% of the examined patients, stage 2 in 18.2%, stage 3 in 42.6%, and stage 4 in 2.9%. CKD stages 1 and 2 were significantly more common in patients with isolated hypertension, compared with those examined with hypertension + coronary heart disease + T2DM (p = 0.01, p = 0.03, respectively). CKD stage 3 was diagnosed in 100% of patients with T2DM + coronary heart disease. In patients with stage 3 hypertension and 3 FC CHF (NYHA), obesity, the GFR was significantly lower in men than in patients with stage 1 and 2 hypertension, with 2 FC CHF, no obesity, and women. Correlations of GFR with age and duration of hypertension and T2DM were established. The shortcomings of pharmacotherapy of patients with CKD in the hospital were revealed: no one receives IDPP-4 and gliflozins, some patients with low SCF receive metformin, some do not receive angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, statins, and some patients with type 2 diabetes did not undergo proper titration of the dose of hypoglycemic drugs.

Conclusions. CKD stages 1–4 were detected in 68% of patients with hypertension, coronary heart disease, and/or type 2 diabetes in the therapeutic hospital, of which 42.6% had stage 3 and 2.9% had stage 4. The GFR value was associated with the degree of hypertension, FC CHF (NYHA), obesity, sex, age, hypertension duration, and type 2 diabetes. In hospitals, recommendations for pharmacotherapy for patients with CKD are not always followed.

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