The role of mineral and bone metabolism disorders in the development and progression of cardiac and renal pathology in the patients presenting with long-lasting type 1 diabetes mellitus

Biragova M.S.; Gracheva S.A.; Glazunova A.M.; Dubrovskaia T.I.; Martynov S.A.; Manchenko O.V.; Ul'ianova I.N.; Il'in A.V.; Shamkhalova M.Sh.; Shestakova M.V.

doi:https://doi.org/

Biragova M.S.

FGBU "Éndokrinologicheskiĭ nauchnyĭ tsentr" Minzdrava RF

Gracheva S.A.

FGBU "Éndokrinologicheskiĭ nauchnyĭ tsentr" Minzdrava RF

Glazunova A.M.

FGBU "Éndokrinologicheskiĭ nauchnyĭ tsentr" Minzdrava RF

Dubrovskaia T.I.

Fakul'tet fundamental'noĭ meditsiny MGU im. M.V. Lomonosova, Moskva

Martynov S.A.

FGBU "Éndokrinologicheskiĭ nauchnyĭ tsentr" Minzdrava RF

Manchenko O.V.

Éndokrinologicheskiĭ nauchnyĭ tsentr, Moskva

Ul'ianova I.N.

FGBU "Éndokrinologicheskiĭ nauchnyĭ tsentr" Minzdrava RF

Il'in A.V.

FGU Éndokrinologicheskiĭ nauchnyĭ tsentr, Moskva

Shamkhalova M.Sh.

FGBU "Éndokrinologicheskiĭ nauchnyĭ tsentr" MZ RF, Moskva

Shestakova M.V.

Institut diabeta Éndokrinologicheskogo nauchnogo tsentra, Moskva

The role of mineral and bone metabolism disorders in the development and progression of cardiac and renal pathology in the patients presenting with long-lasting type 1 diabetes mellitus

Authors:

Biragova M.S., Gracheva S.A., Glazunova A.M., Dubrovskaia T.I., Martynov S.A., Manchenko O.V., Ul'ianova I.N., Il'in A.V., Shamkhalova M.Sh., Shestakova M.V.

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Journal: Problems of Endocrinology. 2013;59(5): 16‑24

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Biragova MS, Gracheva SA, Glazunova AM, et al. . The role of mineral and bone metabolism disorders in the development and progression of cardiac and renal pathology in the patients presenting with long-lasting type 1 diabetes mellitus. Problems of Endocrinology. 2013;59(5):16‑24. (In Russ.)

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Abstract:

The present study included a total of 96 patients with long-lasting type 1 diabetes mellitus (DM1) and early (0-5) stages of chronic renal disease (CRD). Replacement renal therapy (RRT) consisted of programmed hemodialysis (PHD) and kidney transplantation (KT). Routine clinical examination was supplemented by the assessment of phosphorous and calcium metabolism indices, measurement of cardiac pathology markers, and studies of coronary artery calcification with the use of multispiral computed tomography (MSCT) of the heart with the calculation of the Agatston score index. It was shown that the impairment of the renal function was accompanied by a rise in the phosphorus, parathormone, and FGF-23 levels, increased vitamin D deficiency (with a slight deviation of its levels from the reference values in the patients at high risk of cardiovascular events treated with PHD). In the patients who had undergone KT and showed fairly good function of the renal transplant, the above parameters were similar to those of the patients with stage 0-4 CRD which suggested their normalization in case of adequate RRT during DM1. The progress of cardiovascular pathology with the deterioration of the renal function was manifested as an increase of NT-proBNP levels in parallel to the duration of CRD (r=0.304; p<0.05), decrease of the glomerular filtration rate (p=-0.540; p<0.05), and their significant correlation with the main characteristics of mineral homeostasis. The degree of coronary artery calcification was related to the patients' age, duration of DM1, and severity of arterial hypertension. The high Agatston score index and pronounced left ventricular hypertrophy in the patients following KT are supposed to reflect the irreversible character of certain cardiovascular lesions persisting despite optimal RRT and positive dynamics of phosphorus and calcium metabolism and NT-proBNP levels. It is concluded that the development and progression of renal dysfunction are associated with the disturbances of mineral and bone metabolism that promote further progress of cardiovascular pathology that is the main cause of mortality among this cohort of patients.

Keywords:

diabetes mellitus

chronic renal disease

disturbances of mineral and bone metabolism

coronary artery calcification

Authors:

Biragova M.S.

FGBU "Éndokrinologicheskiĭ nauchnyĭ tsentr" Minzdrava RF

Gracheva S.A.

FGBU "Éndokrinologicheskiĭ nauchnyĭ tsentr" Minzdrava RF

Glazunova A.M.

FGBU "Éndokrinologicheskiĭ nauchnyĭ tsentr" Minzdrava RF

Dubrovskaia T.I.

Fakul'tet fundamental'noĭ meditsiny MGU im. M.V. Lomonosova, Moskva

Martynov S.A.

FGBU "Éndokrinologicheskiĭ nauchnyĭ tsentr" Minzdrava RF

Manchenko O.V.

Éndokrinologicheskiĭ nauchnyĭ tsentr, Moskva

Ul'ianova I.N.

FGBU "Éndokrinologicheskiĭ nauchnyĭ tsentr" Minzdrava RF

Il'in A.V.

FGU Éndokrinologicheskiĭ nauchnyĭ tsentr, Moskva

Shamkhalova M.Sh.

FGBU "Éndokrinologicheskiĭ nauchnyĭ tsentr" MZ RF, Moskva

Shestakova M.V.

Institut diabeta Éndokrinologicheskogo nauchnogo tsentra, Moskva

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