References

arthyper

Артериальная гипертензия

"Arterial’naya Gipertenziya" ("Arterial Hypertension")

1607-419X2411-8524

Antihypertensive League

10.18705/1607-419X-2018-24-3-369-378

arthyper-833

Research Article

Статьи

Articles

Метаболический синдром и почки: патогенетически обоснованные нефропротекция и снижение сердечно-сосудистого риска

Metabolic syndrome and kidney: nephroprotection and reduction of cardiovascular risk

Недогода

С. В.

Nedogoda

S. V.

доктор медицинских наук, профессор, заведующий кафедрой терапии и эндокринологии факультета усовершенствования врачей,

ул. Циолковского, 1, Волгоград, 400001

MD, PhD, DSc, Professor, Head, Department of Therapy and Endocrinology, Faculty of Continuing Medical Education,

1 Tsiolkovsky street, Volgograd, 400001

nedogodasv@rambler.ru

Чумачек

Е. В.

Chumachek

E. V.

кандидат медицинских наук, ассистент кафедры терапии и эндокринологии факультета усовершенствования врачей,

ул. Циолковского, 1, Волгоград, 400001

MD, PhD, Assistant Professor, Department of Therapy and Endocrinology, Faculty of Continuing Medical Education,

1 Tsiolkovsky street, Volgograd, 400001

Цома

В. В.

Tsoma

V. V.

ул. Циолковского, 1, Волгоград, 400001

MD, PhD, Assistant Professor, Department of Therapy and Endocrinology, Faculty of Continuing Medical Education,

1 Tsiolkovsky street, Volgograd, 400001

Саласюк

А. С.

Salasyuk

A. S.

ул. Циолковского, 1, Волгоград, 400001

MD, PhD, Assistant Professor, Department of Therapy and Endocrinology, Faculty of Continuing Medical Education,

1 Tsiolkovsky street, Volgograd, 400001

Смирнова

В. О.

Smirnova

V. O.

аспирант кафедры терапии и эндокринологии факультета усовершенствования врачей,

ул. Циолковского, 1, Волгоград, 400001

MD, Postgraduate Student, Department of Therapy and Endocrinology, Faculty of Continuing Medical Education,

1 Tsiolkovsky street, Volgograd, 400001

Хрипаева

В. Ю.

Hripaeva

V. J.

аспирант кафедры терапии и эндокринологии факультета усовершенствования врачей,

ул. Циолковского, 1, Волгоград, 400001

MD, Postgraduate Student, Department of Therapy and Endocrinology, Faculty of Continuing Medical Education,

1 Tsiolkovsky street, Volgograd, 400001

Палашкин

Р. В.

Palashkin

R. V.

аспирант кафедры терапии и эндокринологии факультета усовершенствования врачей,

ул. Циолковского, 1, Волгоград, 400001

MD, PhD, Assistant Professor, Department of Therapy and Endocrinology, Faculty of Continuing Medical Education,

1 Tsiolkovsky street, Volgograd, 400001

Попова

Е. А.

Popova

E. A.

аспирант кафедры терапии и эндокринологии факультета усовершенствования врачей,

ул. Циолковского, 1, Волгоград, 400001

MD, Postgraduate Student, Department of Therapy and Endocrinology, Faculty of Continuing Medical Education,

1 Tsiolkovsky street, Volgograd, 400001

ФГБОУ ВО «Волгоградский государственный медицинский университет» Министерства здравоохранения Российской ФедерацииРоссияVolgograd State Medical UniversityRussian Federation

2018

30072018

243369378

2018

Недогода С.В., Чумачек Е.В., Цома В.В., Саласюк А.С., Смирнова В.О., Хрипаева В.Ю., Палашкин Р.В., Попова Е.А.

Nedogoda S.V., Chumachek E.V., Tsoma V.V., Salasyuk A.S., Smirnova V.O., Hripaeva V.J., Palashkin R.V., Popova E.A.

Данная работа распространяется под лицензией Creative Commons Attribution 4.0.

This work is licensed under a Creative Commons Attribution 4.0 License.

https://htn.almazovcentre.ru/jour/article/view/833

Поражение почек при метаболическом синдроме является характерным изменением, а микроальбуминурия выступает в качестве одного из диагностических критериев метаболического синдрома. При метаболическом синдроме резко возрастают риск развития хронической болезни почек и ее тяжесть, при этом отмечается прямая зависимость с количеством симптомов метаболического синдрома. Получены данные о наличии взаимосвязи между хронической болезнью почек и всеми компонентами метаболического синдрома, включая ожирение, инсулинорезистентность, артериальную гипертензию. В настоящей статье рассматриваются вопросы медикаментозной нефропротекции у больных с метаболическим синдромом, включая пациентов с неконтролируемой артериальной гипертензией. Обсуждаются возможности применения с этой целью фиксированной комбинации периндоприла аргинин + индапамид. На основании данных доказательной медицины четко обозначены преимущества данной комбинации: благоприятное влияние на адипокины, уровень неинфекционного воспаления, эластичность крупных сосудов, что делает ее единственной эффективной на всех этапах кардиоренального континуума у пациентов с метаболическим синдромом и хронической болезнью почек и подтверждается положительным влиянием на риск развития сердечно-сосудистых и почечных осложнений.

Metabolic syndrome is associated with the kidney damage, and microalbuminuria is listed as one of the key diagnostic criteria of metabolic syndrome. In metabolic syndrome the risk of chronic kidney diseases is significantly increased. Moreover, kidney damage is also more severe in metabolic syndrome than in patients without metabolic disorders, and the severity of kidney damage is directly related to the number of the components of metabolic syndrome. Chronic kidney disease is shown to be associated with all the components of metabolic syndrome, including obesity, insulin resistance, hypertension. This article discusses the issues of drug nephroprotection in patients with metabolic syndrome (MS), including patients with uncontrolled arterial hypertension, in particular, the effectiveness of a fixed combination of perindopril arginine + indapamide. The available evidence clearly shows the advantages of this combination: favorable effect on adipokines, the level of noninfectious inflammation, vascular stiffness, which makes it unique and useful at all stages of the renal continuum in patients with MS and chronic kidney disease. This is confirmed by the reduction of the risk of cardiovascular and kidney complications.

артериальная гипертензияметаболический синдромпериндоприлиндапамидожирениеадипокиныхроническая болезнь почек

hypertensionmetabolic syndromeperindoprilindapamideobesityadipokineschronic kidney disease

References1

World Health Organization, Report of a WHO consultation: definition of metabolic syndrome in definition, diagnosis and classification of diabetes mellitus and its complications. Part I: Diagnosis and classification of diabetes mellitus, 1999.

Chen J, Muntner P, Hamm LL, Jones D W, Batuman V, Fonseca V et al. The metabolic syndrome and chronic kidney disease in U.S. adults. Ann Intern Med. 2004;140(3):167–74.

Chen J, Gu D, Chen CS, Wu X, Hamm L L, Muntner P et al. Association between the metabolic syndrome and chronic kidney disease in Chinese adults. Nephrol Dial Transplant. 2007;22(4):1100–6.

Ninomiya T, Kiyohara Y, Kubo M, Yonemoto K, Tanizaki Y, Doi Y et al. Metabolic syndrome and CKD in a general Japanese population: the Hisayama Study. Am J Kidney Dis. 2006;48 (3):383–391.

Kurella M, Lo JC, Chertow GM. Metabolic syndrome and the risk for chronic kidney disease among nondiabetic adults. J Am Soc Nephrol. 2005;16(7):2134–2140.

Maggio A, Wacker J, Montecucco F, Galan K, Pelli G, Mach F et al. Serum resistin and inflammatory and endothelial activation markers in obese adolescents. J Pediatr. 2012;161(6):1022– 1027.

Maffei M, Halaas J, Ravussin E, Pratley R, Lee G, Zhang Y et al. Leptin levels in human and rodent: measurement of plasma leptin and ob RNAin obese and weight-reduced subjects. Nat Med. 1995;1(11):1155–1161.

Lönnqvist F, Nordfors L, Jansson M, Thörne A, Schalling M, Arner P. Leptin secretion from adipose tissue in women. Relationship to plasma levels and gene expression. J Clin Invest. 1997;99(10):2398–2404.

Meyer C, Robson D, Rackovsky N, NadkarniV, Gerich J. Role of the kidney in human leptin metabolism. Am J Physiol. 1997;273 (5 Pt 1): E903–E907.

Montani J, Antic V, Yang Z, Dulloo A. Pathways from obesity to hypertension: from the perspective of a vicious triangle. Int J Obes. 2002;26(Suppl 2): S28–S38.

Kramer H, Saranathan A, Luke A, Durazo-Arvizu R, Guichan C, Hou S et al. Increasing body mass index and obesity in the incident ESRD population. J Am Soc Nephrol. 2006;17 (5):1453–1459.

Martinez Cantarin M, Waldman SA, Doria C, Frank AM, Maley WR, Ramirez CB et al. The adipose tissue production of adiponectin is increased in end-stage renal disease. Kidney Int. 2013;83(3):487–494.

MenonV, Li L, WangX, Greene T, BalakrishnanV, Madero M et al. Adiponectin and mortality in patients with chronic kidney disease. J Am Soc Nephrol. 2006;17(9):2599–2606.

Menzaghi C, Salvemini L, Fini G, Thompson R, Mangiacotti D, Di Paola R et al. Serum resistin and kidney function: a family-based study in non-diabetic, untreated individuals. PLoS One. 2012;7(6): e38414.

Agrawal S, Shlipak MG, Kramer H, Jain A, Herrington DM. The association of chronic kidney disease and metabolic syndrome with incident cardiovascular events: multiethnic study of atherosclerosis. Cardiol Res Pract. 2012;2012:806102. doi:10.1155/2012/806102

Kunimura A, Amano T, Uetani T, Harada K, Yoshida T, Suzuki A et al. Prognostic impact of concurrence of metabolic syndrome and chronic kidney disease in patients undergoing coronary intervention: involvement of coronary plaque composition. J Cardiol. 2013;61(3):189–195.

Johnson DW, Armstrong K, Campbell SB, Mudge DW, Hawley CM, Coombes JS et al. Metabolic syndrome in severe chronic kidney disease: prevalence, predictors, prognostic significance and effects of risk factor modification. Nephrology (Carlton). 2007;12(4):391–398.

Kim CS, Choi JS, Bae EH, Ma SK, Ahn YK, Jeong MH et al.; Korea Acute Myocardial Infarction Registry Investigators. Association of metabolic syndrome and renal insufficiency with clinical outcome in acute myocardial infarction. Metabolism. 2013;62(5):669–676.

Xu H, Huang X, Arnlöv J, Cederholm T, Stenvinkel P, Lindholm B et al. Clinical correlates of insulin sensitivity and its association with mortality among men with CKD stages 3 and 4. Clin J Am Soc Nephrol. 2014;9(4):690–697.

Chan DT, Watts GF, Irish AB, Ooi EM, Dogra GK. Insulin resistance and the metabolic syndrome are associated with arterial stiffness in patients with chronic kidney disease. Am J Hypertens. 2013;26(9):1155–1161.

Briffa JF, McAinch AJ, Poronnik P, Hryciw DH. Adipokines as a link between obesity and chronic kidney disease. Am J Physiol Renal Physiol. 2013;305(12): F1629–F1636.

Axelsson J, Stenvinkel P. Role of fat mass and adipokinesin chronic kidney disease. Curr Opin Nephrol Hypertens. 2008;17 (1):25–31.

RaikouVD, Gavriil S. Metabolic syndrome and chronic renal disease. Diseases. 2018;6(1):12. doi:10.3390/diseases6010012

Khaled N, Brent M. Relationship between chronic kidney disease and metabolic syndrome: current perspectives. Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy. 2014;7:421–435. doi:10.2147/DMSO.S45183

Dagogo-Jack S, Ovalle F, Landt M, Gearing B, Coyne D. Hyperleptinemia in patients with end-stage renal disease undergoing continuous ambulatory peritoneal dialysis. Perit Dial Int. 1998;18(1):34–40.

Merabet E, Dagogo-Jack S, Coyne D, Klein S, Santiago J, Hmiel S et al. Increased plasma leptin concentration in end-stage renal disease. J Clin Endocrinol Metab. 1997;82(3):847–850.

Sharma K, Considine R, Michael B, Dunn S, Weisberg L, Kurnik B et al. Plasma leptin is partly cleared by the kidney and is elevated in hemodialysis patients. Kidney Int. 1997;51(6):1980– 1985.

Axelsson J, Bergsten A, Qureshi A, Heimbürger O, Bárány P, Lönnqvist F et al. Elevated resistin levels in chronic kidney disease are associated with decreased glomerular filtration rate and inflammation, but not with insulin resistance. Kidney Int. 2006;69(3):596–604.

Malyszko J, Malyszko J, Mysliwiec M. Visfatin, a new adipocytokine, is predominantly related to inflammation/endothelial damage in kidney allograft recipients. Transplant Proc. 2009;41 (1):150–153.

Doumatey A, Zhou J, Huang H, Adeleye J, Balogun W, Fasanmade O et al. Circulating adiponectin is associated with renal function independent of age and serum lipids in West Africans. Int J Nephrol. 2012;2012:730920. doi:10.1155/2012/730920. doi: 10.1155/2012/730920

Sharma K, Ramachandrarao S, Qui G, Usui H, Zhu Y, Dunn S et al. Adiponectin regulates albuminuria and podocyte function in mice. J Clin Invest. 2008;118(5):1645–1656.

Недогода С.В. Ожирение в практике терапевта. М.: Эксмо-Пресс, 2017. 304 с. [Nedogoda SV. Obesity in therapeutical practice.M.: Eksmo-Press, 2017. 304 p. In Russian].

London GM, Asmar RG, O’Rourke MF, Safar ME; REASON Project Investigators. Mechanism(s) of selective systolic blood pressure reduction after a low-dose combination of perindopril/ indapamide in hypertensive subjects: comparison with atenolol. J Am Coll Cardiol. 2004;43(1):92–99.

Карпов Ю. А., Деев А.Д. от имени врачей — участников исследования ПРИВИЛЕГИЯ. Исследование ПРИВИЛЕГИЯ — Престариум В лечении артериальной гипЕртонии: антиГИпертензивнаЯ эффективность и безопасность в сравнении с эналаприлом. Кардиология. 2007;7:35–40. [Karpov IuA, Deev AD. Participants of the PRIVILEGIYA Study. PRIVILEGIYA (Privilige) Study — Prestarium in the treatment of arterial hypertension: antihypertensive efficacy and safety in comparison with enalapril. Kardiologiia. 2007;47:35–40. In Russian].

Ionescu DD. PREFER Investigators. Antihypertensive efficacy of perindopril 5–10 mg/day in primary health care: an open-label, prospective, observational study. Clin Drug Investig. 2009;29(12):767–776.

Fennessy PA, Campbell JH, Mendelsohn FA, Campbell GR. Angiotensin-converting enzyme inhibitors and atherosclerosis: relevance of animal models to human disease. Clin Exp Pharmacol Physiol. 1996;23(8): S30–32.

Koz C, Baysan O, Yokusoglu M¸ Uzun M, Yildirim M, Hasimi A et al. The effects of perindopril on aortic elasticity and inflammatory markersin hypertensive patients. Med Sci Monit. 2009;15(7): PI 41–45.

Nedogoda S, Ledyaeva AA, Chumachok EV, Tsoma VV, Mazina G, Salasyuk AS et al. Randomized trial of perindopril, enalapril, losartan and telmisartan in overweight or obese patients with hypertension. Clin Drug Investig. 2013,33(8):553–561.

The Scientific Committee of the PERTINENT Sub-Study on behalf of the EUROPA-PERTINENT Investigators. PERTINENTperindopril-thrombosis, inflammation, endothelial dysfunction and neurohormonal activation trial: a sub-study of the EUROPA study. Cardiovasc Drugs Ther. 2003;17(1):83–91.

Tropeano A, Boutouyrie P, Pannier B, Joannides R, Balkestein E, Katsahian S et al. Brachial pressure-independent reduction in carotid stiffness after long-term angiotensin-converting enzyme inhibition in diabetic hypertensives. Hypertension. 2006;48 (1):80–86.

Недогода С.В., Смирнова В.О., Хрипаева В.Ю., Палашкин Р. В., Ледяева А. А., Чумачек Е. В. и др. Возможности индапамида в ангиопротекции у пациентов с метаболическим синдромом после терапии тиазидсодержащими комбинациями. Сердце: журнал для практикующих врачей. 2016;15(3):193–197. doi:10.18087/rhj.2016.3.2245 [Nedogoda SV, Smirnova VO, Hripaeva VJu, Palashkin RV, Ledyaeva AA, Chumachеk EV et al. Angioprotective possibilities of indapamide in patients with metabolic syndrome after thiazide-based combinations therapy. Russian Heart Journal. 2016;15 (3):193– 197. doi:10.18087/rhj.2016.3.2245 In Russian].

Недогода С.В., Ледяева А.А., Чумачек Е.В., Цома В.В., Мазина Г.Г., Саласюк А.С. и др. Сравнительная эффективность периндоприла А и лозартана у пациентов с артериальной гипертензией и ожирением. Российский кардиологический журнал. 2012;1(93):63–69. [Nedogoda SV, Ledyaeva AA, Chumachek EV, Tsoma VV, Mazina GG, Salasyuk AS et al. Comparative effectiveness of perindopril A and losartan in patients with arterial hypertension and obesity. Rus J Cardiol. 2012;1(93):63–69. In Russian].

Недогода С.В., Чумачек Е.В., Ледяева А.А., Цома В.В., Саласюк А.С., Смирнова В.О. и др. Оптимизация контроля артериального давления, органопротекции и метаболических нарушений с помощью фиксированной комбинации периндоприла и индапамида у пациентов с артериальной гипертензией. Кардиология. 2017;2:5–11. doi:10.18565/cardio.2017.2.5- 11 [Nedogoda SV, Chumachek EV, Ledyaeva AA, Tsoma VV, Salasyuk AS, Smirnova VO et al. Optimization of blood pressure control, metabolic disorders and target organs protection with perindopril + indapamide fixed combination in treated hypertensive patients. Kardiologiia. 2017;2:5–11. doi:10.18565/cardio.2017.2.5- 11 In Russian].

Недогода С.В. Нефропротекция при сахарном диабете 2 го типа: Уроки исследования ADVANCE. Фарматека. 2011;14:40–43. [Nedogoda SV. Renoprotection in type 2 diabetes mellitus patients: results of the ADVANCE study. Pharmateca. 2011;14:40–43. In Russian].

Dahlöf B, Gosse P, Guéret P. Perindopril/indapamide combination more effective than enalapril in reducing blood pressure and left ventricular mass: the PICXEL study. J Hypertens. 2005;23(11):2063–70.

The authors declare that there are no conflicts of interest present.