Stress-induced dyslipidemia in chronic kidney disease during the war: mechanisms, clinical consequences, piculiarities of correction. Review

The article is devoted to discussion of actual questions of mental and physical stress exertion on dyslipidemia (DLP) phenotype peculiar to chronic kidney disease (CKD) during a war as well as to discussion of clinical consequences of lipid profile changes induced by mentioned stress factors and peculiarities of stress‑induced DLP correction in persons with CKD in the conditions of military time. Complex mechanisms of interaction between stress hormones, insulin, cytokines and metabolism of fat tissue influenced on lipid profile changes in stress‑induced DLP have been considered. Such clinical consequences of stress‑induced DLP in patients with CKD in military time as atherosclerosis, glomerulosclerosis and thromboembolic complications were discussed. Atherogenic effects of stress include NO deficit, vascular endothelial production of cytokines, mitogenesis of vascular smooth muscle cells, insulin resistance, neuropeptide Y effects and modulation of renin‑ angiotensin‑aldosterone system. All these effects are connected with stress‑induced DLP. That’s why it’s important to block or minimize atherogenic action of stress components to save a structure and function of vascular endothelium and vascular wall. A negative influence of unhealthy lifestyle, typical during a war, on lipid profile and efficacy of hypolipidemic interventions is emphasized. The main areas of lifestyle modification, which should be followed even during the war, have been highlighted. The data about peculiarities of the use of hypolipidemic agents to save renal function and to reduce proteinuria have been presented in the paper. Some peculiarities have been elucidated as regards the choice of hypolipidemic drugs, including statins, fibrates, PCSK9 inhibitors and omega‑3 polyunsaturated acids, depending on their renal excretion, CKD stage, DLP phenotype and category of cardiovascular risk. Contemporary European recommendations for DLP correction in individual groups of patients with CKD included dialysis and renal transplantation have been discussed.