Monitoring risk factors and microalbuminuria as methods of preventing the development of chronic kidney disease

Relevance. Chronic kidney disease (CKD) - a progressive disease, which is comparable to the prevalence of diabetes mellitus, hypertension and obesity, leading to serious complications, high disability and mortality of patients. Epidemiological studies to identify risk factors for CKD are changing traditional notions of the relatively low incidence of kidney disease. Identification of risk factors for CKD and research microalbuminuria (MAU) are the available methods of prevention, allowing timely adjustments to lifestyle, physical activity, assign medical diet, nephroprotective therapy slows the progression of chronic kidney disease, reduce the risk of severe complications and treatment costs. Goal. To study the prevalence of risk factors for CKD and severity among MAU patients of Advisory Diabetes Center in Ivanovo city. Material and methods. To determine the prevalence and risk factors of CKD severity in 52 MAU women and 10 men 58-85 years old, average age 68.3±5.3 years, sought medical help in an advisory Diabetes Center conducts research and MAU survey using questionnaires created on the initiative of the Scientific Society of Nephrology Russia in 2011 to determine the risk factors for CKD analyzed questionnaires. MAU investigated using test strips "Mikroalbufan" (by Lachema) and diagnosed by the level of urinary protein excretion in the range of 30 to 300 mg/day, as well as the ratio of albumin/creatinine urine. The presence of MAU indicates the ratio albumin/creatinine urine in men - 2.5-25.0 mg/mmol in women - 3.5-25.0 mg/mmol. An interpretation of MAU research results is also stated. Main results. The majority of patients surveyed in the advisory Diabetes Center, were identified by the main risk factors for CKD. In 82% of patients on observation were diagnosed with 1st degreeobesity. More than half of surveyed patients had arterial hypertension (AH) I-II stage. One third of patients suffer from type 2 diabetes, another 14% of patients in the presence of hyperglycemic diabetes currently require clarification. It should be noted that the absolute majority of patients had family history of GB and other cardiovascular diseases. According to the analysis of questionnaires, created on the initiative of Russian Scientific Society of Nephrology, the kidney changes were revealed in less than 20% of the patients, but complaints of possible renal failure (swelling, pain in the lumbar region, frequent urination) were submitted by more than 1/3 of patients which will undoubtedly require further in-depth survey, followed by a pathogenetic therapy. The studied MAU patients who applied to the consultative Diabetes Center, the prevalence of MAU in patients with various risk factors for CKD was mixed. The highest severity and frequency of MAU (90%) have been reported with the combination of several of the most important risk factors for CKD - type 2 diabetes, obesity and hypertension (p<0.05). In patients with type 2 diabetes with hypertension compared with patients with type 2 diabetes without hypertension is 2 times higher absolute values of the MAU (102.1±36.1 and 53.7±23.8 mg/g, respectively; p<0.05) and the ratio of albumin/urinary creatinine (11.6±4.1 and 6,1±2,7 mg/mmol to 1l, respectively); p<0.05. Test conducted twice within 1 month of test strips "Mikroalbufan" by Lachema. Discussion. The majority of patients who applied to the consultative Diabetes Center, discovered the most important risk factors for CKD: obesity, type 2 diabetes and hypertension. In the presence of obesity in the overwhelming number of patients (82%), only 14% have a satisfactory physical activity, while 31% do not pay attention to her. More than half of surveyed patients have hypertension stage I-II, but of these only 57% receive regular antihypertensive therapy. Against the background of antihypertensive therapy in 56% of patients are not achieved target BP. It should be noted that 26% of the surveyed have a family history of diabetes and require in-depth examination to rule out disorders of carbohydrate metabolism. The studied MAU patients who applied to the consultative Diabetes Center, diagnosed MAU varying frequency and severity. The highest prevalence (90%) and severity of the MAU (p<0.05) were observed with a combination of major risk factors for CKD - type 2 diabetes, obesity and hypertension. Conclusion. Carrying out the survey using questionnaires, created on the initiative of the Scientific Society of Nephrology Russia in 2011, and the definition of MAU in patients seeking medical care in the Diabetes Advisory Centre, revealed the high prevalence of major risk factors for CKD (obesity, type 2 diabetes and hypertension), as well as the early stage of CKD. The study of the prevalence of the major risk factors for CKD according to the analysis of questionnaires allows the further prevention of the development of chronic kidney disease in the early stages of development and in a timely manner to assign low-protein diet and ketoanalogs of essential amino acids (Ketosteril), pathogenetic therapy and renal protection.

risk factors, chronic renal disease, microalbuminuria