CLINICAL AND FUNCTIONAL CHARACTERISTICS OF RENAL DYSFUNCTION IN PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE IN COMBINATION WITH ARTERIAL HYPERTENSION

Abstract

The clinical and functional characteristics of renal impairment in patients with chronic obstructive pulmonary disease combined with arterial hypertension were analyzed. Among patients with chronic obstructive pulmonary disease, left atrial hypertrophy was identified in 13.9% of cases without accompanying arterial hypertension and in 9.37% of cases when arterial hypertension was present as a comorbid condition. In the general group of patients, the hypertrophic type of left ventricular diastolic dysfunction occurs in 26.7% of cases. The observed tendency toward left atrial enlargement may be related to left ventricular diastolic dysfunction. In patients with concurrent chronic obstructive pulmonary disease and arterial hypertension, structural remodeling of the right heart chambers was detected significantly more often than in those without arterial hypertension (21.3% vs. 14%). This is due to the complex picture of structural changes in the right ventricle due to hypertrophy of the interventricular septum and its displacement towards the left ventricle. In addition, the frequency of ventricular diastolic dysfunction in a combination of chronic obstructive pulmonary disease and arterial hypertension is also significantly higher than in the group of patients without arterial hypertension (30.2% versus 51.1%). With the development of chronic obstructive pulmonary disease, the level of cystatin C and microalbuminuria increases significantly. A significant association was identified between the markers of renal dysfunction and parameters of cardiac remodeling, suggesting that hemodynamic factors contribute substantially to the development of chronic kidney disease in patients with chronic obstructive pulmonary disease. Elevated cystatin C levels observed in patients with chronic obstructive pulmonary disease are consistent with findings reported in previous studies. At the same time, such deviations may be associated with the systemic effect of obstructive pulmonary disease, including chronic hypoxia, inflammatory processes, and endothelial dysfunction.