The role of obesity in renal damage in patients with chronic heart failure
THE AIM: to study the functional state of the kidneys in patients with chronic heart failure (CHF) and obesity. PATIENTS AND METHODS. 116 patients with CHF I-III functional class (FC) 45-65 years old are divided into three comparable groups depending on body mass index (BMI). A physical examination was performed, evaluated the renal function, the level of leptin and adiponectin, assessed the insulin resistance index, the combined risk of progression of chronic kidney disease (CKD), and the development of cardiovascular complications was analyzed. RESULTS. Among patients with CHF and obesity, a statistically significant decrease in glomerular filtration rate (GFR) was observed compared with patients of the 1st group (61.3 [46.2; 67.1] vs 73.2 [62.1; 86.3] ml/min / 1.73 m2), a clinically significant decrease in GfR 2 (CKD C3a-3b), high (A2) and very high (A3) albuminuria (AU) compared in patients with normal and overweight. The leptin concentration significantly increased from the 1st to the 3rd group, while the adiponectin concentration decreased from the 1st to the 3rd group. Statistically significant correlations were established between the concentration of leptin and GFR (r = -0.52), AC (r = 0.36), between the concentration of adiponectin and GFR (r = 0.38), AC (r = -0.32). Significant associations were found among patients with overweight and obesity between the severity of AU, GFR, and HOMA-IR, metabolic index. CONCLUSION. A significant deterioration in the functional parameters of the kidneys in patients with CHF with increasing body weight, as well as an increase in the combined risk of CKD progression and the development of cardiovascular complications with comparable FC, was established. The revealed reliable relationships reflect the significant pathogenetic contribution of the hormonal activity of visceral adipose tissue and insulin resistance to the development and progression of renal dysfunction in patients with heart failure and obesity.