Clinical and pathogenetic features of cardiorenal syndrome and predictors of its formation in patients with type 1 and type 2 diabetes in the post-Covid period

Abstract

Among the negative consequences of the coronavirus disease (COVID-19) pandemic, the outbreak of which began in Wuhan, the seventh largest city in China, was the deterioration of the cardiorenal system, especially in patients with diabetes mellitus (DM). The relevance of the problem is due to the fact that these conditions have a number of common pathogenetic mechanisms leading to mutual aggravation. Diabetic patients who have had COVID-19 form are a specific category of polymorbid patients with a combination of heart failure, and chronic kidney disease (CKD). Cardiorenal syndrome (CRS) is a pathophysiological disorder of the heart or kidneys, in which dysfunction of one organ can lead to deterioration of the work of the other. As a result, general decompensation develops and mortality increases among patients. The formation and progression of existing CRS in patients with type 1 and type 2 diabetes (T1D and T2D) occurs by different mechanisms. Patients with T2D more often develop CRS type 2 or 5, and patients with T1D – CRS type 4. The main criterion for the CRS severity is the presence of albuminuria, not the estimated glomerular filtration rate (eGFR). The aim is to study the clinical and pathogenetic features and predictors of the formation of cardiorenal syndrome in patients with T1D and T2D in the post-COVID period. Material and methods. The work was carried out on the basis of the Department of Diabetology of the State Institution «V.P. Komisarenko Institute of Endocrinology and Metabolism of the National Academy of Medical Sciences of Ukraine» (hereinafter referred to as the Institute). During 2000-2024, 792 patients with T1D and T2D were examined and treated, 84% of whom had COVID-19. The average age of patients was (33.8±1.04 years), with diabetes duration from
4 to 38 years (16.00±1.33 years). Results. As a result of the study,CKD was diagnosed in 38% of patients with DM and 67% of patients with T2D, among whom the albumin / creatinine ratio less than 30 mg/g was found only in 27.9% of patients, high-grade albuminuria – in 72.1%. When determining the level of apolipoprotein
A1, its significantly lower level was found in the blood of patients with diabetes mellitus and especially with COVID-19 compared to healthy people, which may be one of the promising markers of severe COVID-19. In addition, an increase in the level of a pathogenetically significant indicator that plays an important role in the development and progression of CKD, namely the profibtrotic cytokine transforming growth factor beta 1, was observed in the blood serum of patients with T1D before the appearance of albuminuria, i.e. in the early stages of CKD, and its increase as this complication progresses. Symptoms of depression in hospitalized patients with DM were diagnosed in 74.3% of patients, on average 2 times more often in women than in men, most often in women with T2D of the older age category (60-75 years), in whom a severe form of depression is often observed. Conclusions. Thus, studying the features of the formation of CRS in the post-COVID period depending on the type of diabetes, military stress, and the duration of carbohydrate metabolism disorders made it possible to develop and implement a clinical and diagnostic algorithm for optimal diagnostic and treatment regimens for this category of patients.