Abstract
Background and Aims
According to recently published WHO data, kidney disease has been the 10th leading cause of death in the world over the past 20 years. The lethality of dialysis patients with cardiovascular pathology is 3 times higher than that of patients without CVD. This is especially pronounced in developing countries. Uzbekistan is a country with a population of 34 million and has an equal urban and rural population. In this regard, it is of interest to comparatively study the structure of CVD in patients with CKD stage 5D of the rural and urban population of Uzbekistan.
Method
We examined 165 (90 men and 75 women) patients with CKD stage 5 receiving dialysis in urban and rural areas of Uzbekistan. The patients were divided into 2 groups depending on their permanent place of residence and the medical center where they receive hemodialysis. 104 (51 men and 53 women) patients were included in the Urban group and 61 (39 men and 22 women) patients were included in the Rural group. The average age of the urban population was 49.7 ± 1.38 years, the rural population was 45.5 ± 1.83 years. All patients underwent programmed hemodialysis according to the standard scheme for 4 hours 3 times a day (12 hours/week). The average duration of hemodialysis in the Urban group was 37.0 ± 4.77 months (M ± m) and 16.6 ± 2.4 months in the Rural group. The main causes of CKD 5D in both groups were glomerulonephritis (Urban-36.5%, Rural-62%) and type 2 diabetes (Urban-31.7%, Rural-18%).
Results
CVD comorbidity occurred in 55,8% (n=92) of all 165 examined patients, of which 52 were men and 40 were women. The most common CVDs in all groups were hypertension (51%, n=84), coronary heart disease, presented as angina (28%, n=47), heart failure (14%, n=23) and various types of arrhythmias (5%, n=8). 77% (n=127) of patients had anemia due ESRD. In the group Urban(n=104), 62.5% (n=65) had CVD. The main CVD was Hypertension. It was found in 92% (n=60) of patients with CVD in this group. Less (65%, n=42) were patients with angina. Heart failure was detected in 31% (n=20) of patients. Arrhythmia was diagnosed in only 5% (n=5). A large number of combined CVD have been identified. 69% (n=45) of all patients with CVD had a combined CVDs in different combinations. The most common combination was hypertension + angina (n = 26). It accounted for almost 58% of all combined cases. Only 28% (n=17) of all cases with hypertension had "isolated" hypertension. The main combination with hypertension was hypertension + angina (43%, n=26), 11% (n=11) of patients had hypertension + angina + heart failure, a combination in the form of hypertension + angina + arrhythmia had 3% (n=3) patients. Relatively fewer (n = 27, 44%) CVD were found in the Rural group. The most frequent CVD was also a hypertension. Patients with hypertension made up 89% (n = 24) of all patients with CVD in this group. The second place is occupied by angina, it was found in 18.5% (n=5) cases among patients with CVD. Combined CVS pathologies were less common in the rural group. A total of 8 patients (29.6% of all CVD cases) had several CVDs.
Conclusion
Сardiovascular diseases in the urban population (62.5%) occur almost one and a half times more often than in the rural population (44%). Combined CVD pathology occupies a leading place in the structure of CVD in patients with CKD 5D, both urban and rural.
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