THE EFFECT OF NATIVE VITAMIN D THERAPY ON ECHOCARDIOGRAPHIC PARAMETERS OF PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE AND EARLY-STAGE CHRONIC KIDNEY DISEASE
Aim. To assess the dynamics of the main echocardiographic parameters in patients with chronic obstructive pulmonary disease (COPD) and early-stage chronic kidney disease (CKD) taking native vitamin D. Material and methods. The study included 264 patients, which were divided into two groups: experimental group (n=135) - patients with stage 2-4 COPD (men, mean age - 72,2±3,8 years, mean disease duration - 23,1±3,4 years); control group (n=136) - patients with stage 2-4 COPD, comparable in age and sex. Patients of both groups were divided into 4 subgroups depending on forced expiratory volume in 1 second and vitamin D levels. In the experimental group, native vitamin D therapy was performed according to regimen that maintains its level >34,3 ng/ml during the year; in the control group - according to the Russian Association of Endocrinologists guidelines. Echocardiography was performed for all patients at the beginning and end of the study. Results. In all subgroups of the experimental group, a statistically significant increase in the left ventricular ejection fraction was revealed (p<0,05); in patients with moderate COPD (GOLD 2) and vitamin D deficiency and patients with severe and very severe COPD (GOLD 3,4) and vitamin D insufficiency of the experimental group, we observed a significant decrease in the end-systolic dimension, average left atrial size and increase in stroke volume and stroke volume index, as well as normalization of the left ventricular geometry (p<0,05). In the control group after 12 months, no significant changes were detected. Conclusion. Maintaining of vitamin D level >34,3 ng/ml for 12 months in patients with COPD and early-stage CKD was associated with a significant improvement in myocardial remodeling. This indicates an improvement in cardiovascular adaptation and function.