Left Ventricle Structural and Functional Peculiarities in Patients with Diabetic Nephropathy

The combination of diabetes mellitus and chronic kidney disease, which occurs in diabetic nephropathy, is accompanied by a significant increase of cardiovascular complications. This fact can be explained by traditional (hypertension, dyslipidemia, hyperglycemia, obesity) and additional non-traditional risk factors (atherogenesis, albuminuria, systemic inflammation, anemia and others). However, the mechanisms of accelerated development of cardiovascular pathology in this category of patients are still unexplained. The purpose of this work was to investigate the structural and functional parameters of the heart in patients with type 2 diabetes depending on kidneys functional state. Material and methods. We observed 64 patients with type 2 diabetes mellitus. Сontrol group consisted of 20 healthy people. Patients were divided into the following groups: group I included patients with normal glomerular filtration rate and albuminuria, group II comprised patients with reduced glomerular filtration rate and albuminuria, group III had patients with type 2 diabetes without signs of nephropathy. Assessments of cardiac structure and function were performed by echocardiography. The following echocardiographic parameters were ascertained: interventricular septal thickness and left ventricular posterior wall thickness, left ventricular mass index, left ventricular ejection fraction and diastolic dysfunction. Glomerular filtration rate was estimated by EPI equations. Results and discussion. Obtained results showed that in patients with type 2 diabetes with albuminuria and a decrease in the glomerular filtration rate, a significant increase of left ventricle linear parameters was found when compared with control group and patients with type 2 diabetes without the signs of nephropathy. Conclusions. The study showed that diabetic nephropathy was accompanied by diastolic function decrease, which became more pronounced as the disease progressed. The obtained data indicate doubtless relationship between the cardiac structural and functional changes and progression of renal dysfunction in type 2 diabetes mellitus. We suggest that structural and functional rearrangement of the left ventricle should be taken into account when determining the cardiovascular prognosis in diabetic patients with nephropathy.