COPD is associated with several comorbidities. But it is unknown to which extent it is associated with chronic renal failure.
Chronic renal failure rises in prevalence with age, and is frequently associated with chronic diseases, such as congestive heart failure and diabetes mellitus.
When chronic renal failure presents as a comorbidity, it carries negative prognostic implication and impacts the therapeutic strategy.
In elderly patients, who are the majority of those suffering from chronic disabling condition ,chronic renal failure is often associated with normal serum creatinine concentration, a condition known as unrecognized or concealed chronic renal failure..
The aim of this work was to assess the prevalence of concealed and overt chronic renal failure in patients with COPD.
This case control cross sectional study was conducted on 150 patients in Benha University Hospital at the chest and internal medicine outpatient clinics during the period from October2013 to April 2015.
After application of inclusion and exclusion criteria, patient’s demographic data, pulmonary function results, laboratory investigations and estimation of GFR by MDRD equation were done:-
170×[serum creatinine]-0.999×[age]-0.176×[blood urea]-0.170×[serum albumin]0.318×(0.762for women)×(1.180for African-American subjects).
The patients were classified into 3 groups:
Group I was 67 patients with COPD only.
Group II was 33 patients with COPD and other comorbidities.
Group III (control group) included 50 patients with other diseases as DM, HTN and IHD.
It was found that:-
There was highly statistical significant difference between COPD groups (group I and II) as regards duration of disease and smoking index as they were higher in group II. There is no statistical significant difference between the 3 groups regarding age, sex and BMI.
Regarding hemoglobin concentration, there was highly statistical significant difference between group I and III and between group II and III as it was lower in group III.
Regarding Sao2, there was statistical significant difference between group I and II as it was lower in group II and between group II and III as it was lower in group II.
Regarding serum urea, there was statistical significant difference between group II and III as it was higher in group II.
Regarding total cholesterol, there was highly statistical significant difference between group I and II and between group II and III as it was higher in group II.
Regarding serum CRP, there was statistical significant difference between group I and II as it was higher in group II and between group I and III as it was higher in group I and between group II and III as it was higher in group II.
Regarding serum sodium, there was statistical significant difference between group II and III as it was higher in group II.
Regarding GFR, there was statistical significant difference between group I and II as it was lower in group II.
There was no statistical significant difference between the 3 groups regarding ESR, total protein, serum albumin, creatinine, potassium and chloride.
There was no statistical significant difference between group I and II as regard pulmonary function parameters (FEV1, FEV1/FVC, and post bronchodilator FEV1 change).
There was no statistical significant difference between group I and II regarding disease severity. However, severe airway obstruction was the commonest in both groups.
There was a high prevalence of CRF (concealed and overt) among COPD patients. As the overall prevalence of CRF was 18.7% (28/150). In COPD (group I and II) was 19% (19/100), while in control group (group III) was 18% (9/50).
There was no statistical significant difference between the studied groups regarding the presence of renal failure (overt and concealed). However, the presence of renal failure was higher in group II
There was statistical significant difference between COPD patients with and without renal failure regarding hemoglobin concentration as it was lower in cases with renal failure.
There was statistical significant difference between COPD patients with and without renal failure regarding Sao2 as it was lower in cases with renal failure; there was also highly significant increase in age, urea, total cholesterol and potassium in cases with renal failure.
There was highly statistical significant decrease in GFR in cases with renal failure.
There was statistical significant increase in the incidence of renal failure in cases with severe and very severe COPD than cases with moderate severity.
There was statistical significant increase in smoking index in cases with renal failure.
There was no statistical significant difference between COPD patients with and without renal failure as regards duration of disease, BMI, CRP and sodium.
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