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Analysis of the effect of tubular dysfunction on the likelihood of developing cardiovascular complications in patientswith hypertension in the late period after acute coronarysyndrome

Authors :
V. V. Gulchenko
E. S. Levitskaya
A. V. Khripun
M. M. Batiushin
Source :
Nephrology (Saint-Petersburg). 24:43-50
Publication Year :
2020
Publisher :
Non-profit organization Nephrology, 2020.

Abstract

BACKGROUND. The study of the prognostic significance of markers of tubular dysfunction in patients with the acute coronary syndrome (ACS) and arterial hypertension (AH) is highly relevant, due to the unity of pathogenetic mechanisms and their consequences that develop during an acute coronary event. PURPOSE. Analysis of the influence of tubular dysfunction indi­cators on the risk of cardiovascular complications in patients with hypertension in the late period after ACS. PATIENTS ANDMETHODS. The study included 103 patients with hypertension and ACS. All patients included in the study underwent coronary angiography (CAG) with stenting of the coronary arteries. Before CAG, clinical and anamnestic data were collected, labora­tory (including creatinine and urea, potassium and sodium, plasma osmolarity), and instrumental diagnostic methods were used. The concentration of potassium and sodium in the daily urine, potassium and natriuresis, osmolarity of urine, and the calculated osmolar clearance index (ОС) were determined. Impedance spectrometry was performed to determine the water balance of the body's liquid media. After 17.0±0.51 months, the endpoints of the study were registered: AMI, NS, stable stress angina, repeated myocardial revascularization (RM), and death. RESULTS. It was found that an increase in ОС is associated with the risk of developing repeated RM in the late period after ACS (x2-criterion = 3.89, p = 0.04). Among the indicators of the electrolyte balance of urine, a statistically significant effect on the risk of repeated RM was found with an increase in the con­centration of potassium in the urine (x2-criterion = 4.63, p = 0.03) and daily potassium urea (x2-criterion = 4.85, p = 0.03). The ОС index and an increase in the electrolyte balance of urine were considered and justified as markers of tubular dysfunction. The complex effect of increasing the ОС and reducing the volume of intracellular fluid from the proper values (x2-criterion = 6.16, p = 0.4) on the risk of repeated RM was established. It was found that when the balance of the volume of total fluid and CA is changed, the risk of developing repeated RM is potentiated. It is shown that with the excessive introduction of fluid volume into the body, mainly intravenously and an increase in ОС, the risk of developing repeated RM increases significantly. CONCLU­SION. The study revealed that the presence of tubular dysfunction can be considered as a predictor of adverse cardiovascular prognosis in patients with ACS and hypertension. For a comprehensive analysis of the risk value, it is necessary to control homeostasis and individual selection of the volume of intravenous infusions.

Details

ISSN :
25419439 and 15616274
Volume :
24
Database :
OpenAIRE
Journal :
Nephrology (Saint-Petersburg)
Accession number :
edsair.doi...........2977e291a411a6e8f3bf2c674b89cc80
Full Text :
https://doi.org/10.36485/1561-6274-2020-24-5-43-50