Fundamentals of the formation of cardio–reno–metabolic syndrome and its consequences. Clinical case

Cardio–reno–metabolic (CRM) syndrome is defined as a combination of cardiovascular, renal, and metabolic disorders, in which type 2 diabetes mellitus (T2DM) and obesity play a central role. The presence of this comorbidity is associated with adverse cardiovascular (CV) and renal outcomes. Five stages of CRM syndrome are distinguished (from 0 to 4). Stage 0 is characterized by the absence of CV risk factors, chronic kidney disease (CKD), and metabolic disorders. The clinical manifestation of CV diseases (coronary artery disease, heart failure, stroke, peripheral arterial disease, atrial fibrillation) in the presence of overweight or obesity and CKD risk factors indicates stage 4 CRM syndrome, which is associated with severe outcomes. Objective — to analyze risk factors and stages in the development of cardio–reno–metabolic syndrome based on a clinical case, and to determine the stage and consequences of the comorbid condition. On examination: body mass index (BMI) 28.4 kg/m²; arrhythmic cardiac activity with atrial fibrillation; blood pressure 170/90 mmHg; pulse 47 — 54/min. Laboratory findings included hypercholesterolemia (5.7 mmol/L), hypertriglyceridemia (2.7 mmol/L), hyperglycemia (15.9 mmol/L), elevated serum creatinine (162.3 mmol/L), hyperuricemia (530.4 mmol/L), hyperfibrinogenemia (5.3 g/L), elevated erythrocyte sedimentation rate (18.5 mm/h), borderline leukocytosis (9.0 · 109/L), HbA1c 9.7%, and increased urea and transaminase levels. Urinalysis: albumin 30 mg/L, creatinine 50 mg/dL, urinary albumin-to-creatinine ratio (UACR) 60 mg/g. Estimated glomerular filtration rate (eGFR) was 39 mL/min/1.73 m². Instrumental findings: left ventricular ejection fraction (LVEF) 46%, sclerotic changes in cerebral vessels, angiopathy of both lower extremities, hepatomegaly. Diagnosis: T2DM complicated by peripheral polyneuropathy with lower limb angiopathy and diabetic retinopathy with bilateral cataracts. Diabetic kidney disease (stage 3B), CKD (stage 2). Concomitant conditions: coronary artery disease, diffuse cardiosclerosis, atrial fibrillation (bradysystolic form), hypertension stage III (ischemic stroke in 2021), grade 2, risk IV, heart failure stage IIA, dyscirculatory encephalopathy (dysmetabolic, hypertensive, atherosclerotic). This comorbidity corresponds to stage 4A cardio–reno–metabolic syndrome with progression toward stage 4B. Conclusions. Type 2 diabetes, especially in the presence of excess body weight, plays a fundamental role in the formation of cardio-reno-metabolic syndrome due to metabolic disorders, chronic low-intensity inflammation with the development of microvascular and macrovascular lesions. Long-term course of type 2 diabetes mellitus with failure to achieve glycemic control, concomitant hypertension with uncontrolled blood pressure variability along with dyslipidemia, hyperuricemia, fatty hepatosis contribute to the unfavorable course of cardio-reno-metabolic syndrome with severe cardiovascular and renal consequences.