Analysis of the factors of survival to renal replacement therapy in patients with chronic kidney disease

Abstract

Background. The relationship between chronic kidney disease (CKD) and cardiovascular diseases is important and is characterized by the presence of numerous adverse factors compared with patients with cardiovascular disease alone. The purpose of the study is to evaluate the incidence of risk factors for cardiovascular complications, nephrological risk factors and their combination in patients with CKD stage IV–V, who survived to the stage of renal replacement therapy. Materials and methods. Retrospectively, we have analyzed medical records (for 2 years) of 42 patients (12 (28.6 %) men, 30 (71.4 %) women) with CKD stage IV–V, who by the time of medical records analysis did not receive renal replacement therapy. All patients underwent the following measurements: body mass index, blood pressure, heart rate, complete blood count and biochemical blood test, the level of residual diuresis. To determine glomerular filtration rate (GFR), we used Chronic Kidney Disease Epidemiology Collaboration equation. Statistical processing of research materials was performed by means of Statistica v. 6.1 software package (Statsoft Inc., USA). Results. The mean age of patients was 47.6 ± 11.6 years. The study showed that patients with CKD, who survived to renal replacement therapy, had daily diuresis more than 500 ml, heart rate less than 90 bpm. Systolic blood pressure in such patients was maintained with drugs at the level of not less than 160 mmHg. The level of total cholesterol more than 4.5 mmol/l and body mass index more than 25 kg/m² were also characteristic features. We found a direct correlation between GFR and total cholesterol (r = 0.32, p = 0.04), GFR and hemoglobin (r = 0.39, p = 0.01) and a direct correlation between GFR and the amount of residual urine (r = 0.32, p = 0.04). Conclusions. The most significant factors of survival of a patient with CKD before renal replacement therapy are: young age (under 40 years), presence of residual urine (daily diuresis more than 500 ml/day), absence of diabetes mellitus. The control of anemia and systolic blood pressure < 160 mmHg are of particular importance.