Chronic Kidney Disease and Ischemic Heart Disease. Medical and Social Aspects

Chronic kidney disease (CKD) is a clinical, laboratory, and instrumental syndrome that develops against the background of the gradual and irreversible loss of nephrons. A key laboratory indicator of CKD is a decrease in the glomerular filtration rate (GFR) to ≤ 60 mL/min/1.73 m². Anemia, hyperuricemia, hyperphosphatemia, and arterial hypertension are the most common conditions accompanying CKD. In the etiological structure of CKD, the leading causes include type 2 diabetes mellitus (T2DM), hypertension, chronic heart failure (CHF), and interstitial nephropathies. Patients with CKD are classified as high or very high cardiovascular risk. Common cardiovascular manifestations in CKD include diastolic dysfunction and left ventricular hypertrophy, high-grade arrhythmias, ischemic heart disease (IHD), and CHF. The pathogenesis of IHD in CKD is characterized by disturbances in lipid, calcium-phosphate, and purine metabolism. In CKD patients, anemia, proteinuria, and hypertension accelerate the development of IHD. Frequent episodes of myocardial ischemia in CKD lead to collagen accumulation and fibrosis, resulting in increased left ventricular stiffness and diastolic dysfunction. Coronary angiography in CKD patients often reveals multivessel and diffuse coronary artery lesions. In end-stage CKD, pronounced coronary artery calcification is observed. The morphological substrate of IHD in CKD is represented by athero- and arteriosclerotic coronary artery damage. Severe coronary calcification complicates stent placement, and the hypertrophied myocardium becomes highly sensitive to reduced hemoglobin levels. The article presents a clinical case of combined CKD and IHD in an elderly patient with a background of T2DM.