RENAL FUNCTION IN HYPERTENSIVE PATIENTS WITH ATRIAL FIBRILLATION: ASSOCIATION WITH SYSTEMIC FIBROSIS, INFLAMMATION AND CARDIAC FUNCTION

Objective. To study the renal function in relation to fibrosis, inflammation and left ventricular ejection fraction in patients with essential hypertension (HTN) and atrial fibrillation (AF). Design and methods. The main group included 69 males with HTN and AF, the control group consisted of 17 hypertensive males without AF. The average age was 55,0 (50,0–57,0) and 52,0 (45,0–56,0) years old, respectively. We identified firstmorning urine albumin, plasma creatinine, cystatin C, high-sensitivity C-reactive protein (hsCRP), and matrix metalloproteinase-2 (MMP-2). Glomerular filtration rate (GFR) was calculated by the CKD-EPI formula based on creatinine and cystatin levels. Left ventricular ejection fraction (EF) was determined by echocardiography. All the parameters were compared in the study groups, as well as in patients with different forms of AF. We also evaluated fibrosis and inflammation severity as well as cardiac function in relation to renal function. Results. In the main group the level of cystatin C was higher and GFR lower than in the control one (1,4 (1,2–1,7) and 1,2 (1,0–1,4) mg/l, p = 0,015; 62,2 (54,9–73,2) and 73,2 (66,1–78,6) ml/min/1,73 m 2, p = 0,01). The groups differed in the incidence of GFR < 60 ml/min/1,73 m 2 (40,6 and 11,8 %, respectively; p = 0,025). Paroxysmal AF was diagnosed in 29 men (42,0 %), persistent AF — in 17 (24,6 %), and permanent AF — in 23 cases (33,4 %). Cystatin C level increased from 1,3 (1,1–1,4) mg/l in paroxysmal AF up to 1,7 (1,2–1,8) mg/l in persistent AF and up to 1,5 (1,3–1,7) mg/l in permanent AF (p = 0,006). Plasma MMP-2 level was higher in AF patients than in the control group (16,4 (13,9–19,3) and 11,3 (9,8–12,1) ng/ml, respectively; p < 0,001). It also increased from 14,6 (12,1–18,4) ng/ml in paroxysmal AF up to15,5 (12,9–16,5) ng/ml in persistent AF and to 18,0 (16,4–21,6) ng/ml in permanent AF (р = 0,009). In the main group mean EF was lower than in the control group (65,0 (60,0– 68,0) and 68,0 (66,0–71,0) %; p < 0,001). The following correlations were found in HTN patients with AF: hsCRP with cyctatin C (r = 0,34, р = 0,004) and GFR (r = –0,28, р = 0,02); EF with cyctatin C (r = –0,34, р = 0,004) and GFR (r = –0,34, р = 0,004). No significant correlations between MMP-2 and renal indicators were found. Conclusions. In HTN patients with AF compared to HTN patients with sinus rhythm, MMP-2 and cystatin C serum levels are higher while GFR is lower. Renal dysfunction and fibrosis severity increase in patients with permanent AF compared to persistent and paroxysmal forms. Deterioration of renal function at AF is associated with inflammation increase and left ventricular EF decline in the absence of MMP-2 level change. 

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