Changes in renal blood flow in patients with chronic obstructive pulmonary disease under the influence of treatment

Abstract

Aim. Study of the features of renal blood flow and correction of its disorders in COPD patients at different stages of the formation of chronic cor pulmonale (CCP).Materials and methods. Examination of 38 patients with COPD complicated by CCP (26 men and 12 women) was carried out, mean age was 61.9±0.56 years, smoking history was 29.6±2.9 pack/years. The complex treatment included Perindopril (Servier, France) for 6th months. The patients were divided into two groups: group 1 included 20 patients with COPD with compensated CCP, group 2 included 18 patients with decompensated CCP.Results. During treatment in group 1, patients showed normalization of end-diastolic velocity in the interlobar renal arteries (Wilcoxon T-test, p=0.01), pulsation and resistance indices (Wilcoxon T-test, p=0.01), systolic-diastolic ratio of speeds (Wilcoxon T-test, p=0.001). By the end of the observation, the functional capacity of the right ventricle (RV) in patients of group 1 practically did not differ from that of healthy individuals (Mann-Whitney U Test, p=0.1). The left ventricle (LV) ejection fraction increased (Wilcoxon T-test, p=0.1), no signs of diastolic dysfunction were detected. There was a decrease in total peripheral vascular resistance (TPVR) (Student's t-test, p=0.01). An improvement in renal function was observed (Wilcoxon T-test, p=0.001). In patients of group 2, after treatment, there was a significant increase in end-diastolic velocity (Wilcoxon T-test, p=0.02) and a decrease in vascular resistance in the renal arteries (Wilcoxon T-test, p=0.02). A decrease in systolic pressure in the pulmonary artery was revealed (Student's t-test, p=0.01), indicators of diastolic and systolic right ventricle function improved (Wilcoxon T-test, p=0.01). There was an improvement in the contractility of the left ventricle, a decrease in total peripheral vascular resistance. Glomerular filtration rate improved after treatment (Wilcoxon T-test, p=0.01), but did not return to normal (Mann-Whitney U Test, p=0.01).Conclusion. The use of perindopril in COPD patients with compensated CCP leads to the normalization of pulmonary, intracardiac, renal hemodynamics and improvement of these parameters in COPD patients with decompensated CCP.