Background RA pts commonly present with multiple concurrent chronic disease. The great importance is attached to cardiovascular diseases due to their proven association with high frequency of morbidity and death. Much attention has been paid to the potential role of high-grade systemic inflammation and classical modifiable CVD risk factors – such as hypertension, dyslipidaemia, insulin resistance/metabolic syndrome, obesity, physical inactivity and smoking. A recent meta-analysis has shown that renal impairment is a strong independent cardiovascular risk factor in the general population .
Objectives To assess the prevalence and associations of CKD in RA pts (ACR/EULAR 2010y.) and relate with pts multimorbid background, RA activity and duration.
Methods 209 RA pts (F-70,6%, mean age 67,0±11,3y), admitted to rheumatology division from 1999 to 2015, were included into analysis. RA duration was 19 [6;93] mo, average disease activity (DAS28) 5,2±1,7. CKD was defined as the presence of markers of renal impairment (proteinuria≥1+, hematuria≥2+ or leucocyturia≥2+) and/or eGFR<60 ml/min/1,73m2 (using CKD-EPI formula) persistent beyond 3 months. The extent of multi-morbid environment was rated using Cumulative Illness Rating Score (CIRS) . CIRS was calculated using the 5 score scale (0–4) to assess 14 major organ systems of the body (0–56).
Results The prevalence of CKD was 82,3% (172), and 30,1% (63) had eGFR<60 ml/min/1,73m, and 50,2% pts had CKD stage 2. The range of proteinuria was 12,4%. In group of pts with CKD 3–5 stage the prevalence of arterial hypertension (AH) was 84%, ischemic heart disease (IHD) - 63,5%, diabetes militants 2 22%, oncology 12,7%. Mean CIRS value in RA pts was 15 [10;19] scores. The eGFR was independent of the RA duration (r=-0,01, p=0,86) and RA activity (r=0,09, p=0,17). There was found the strongest correlation of eGFR with CIRS (r=-0,61, p<0,01), age (r=0,58; p<0,05), AH (r=-0,34, p<0,01), IHD (r=-0,28, p<0,05), BMI (r=-0,17; r=0,35), uric acid levels (r=-0,37), as well as with hemoglobin level (r=0,19) and HAQ scores (r=0,31; r=0,32). No correlation was found between eGFR and oncology, gender, VAS score, and ESR, CRP, cholesterol (p>0,05).
Conclusions CKD is a serious condition associated with premature mortality, decreased quality of life, and increased health-care expenditures, but it doesn't consider as comorbid disorder of RA. The CKD prevalence is greater among aged RA pts than in general population and it has a stronger correlation with multimorbid burden than traditional factors. Compromised renal function, apart from the age, is of dominant importance in pts management issues, limiting the range of available effective therapies, thus, aggravating RA natural course on one side, and inducing and catalyzing the severity of dysmetabolic syndrome, AH and anemia – on the other.
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Disclosure of Interest None declared