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Scripta Scientifica Medica


Elena Bolotova, Anna Dudnikova


Introduction: It is considered that the main comorbid diseases in chronic obstructive pulmonary disease (COPD) are cardiovascular disease, osteoporosis, anxiety and depressive illness. However, there are few reports of chronic kidney disease (CKD) as a comorbidity of COPD.

Materials and methods: The study included 198 patients with a diagnosis of COPD. The patients were divided into four groups according to the degree of COPD severity. In all the patients, calculation of glomerular filtration rate (GFR) based on formulas of СКD-EPI with serum creatinine and serum cystatin C was performed.

Results: GFR calculation by creatinine showed that the frequency of individuals with normal GFR>90 mL/min/1.73 m2 was significantly higher than than that of cystatin C (48% versus 12.6%, χ2=52.97, p<0.05). For the group of patients with decreased GFR in the range of 59-45 mL/min/1.73 m2, there were opposite results: the frequency of patients with calculation of GFR by cystatin C (34.3% versus 1%, χ2=48.87, p<0.05) was significantly higher. Similar data were obtained comparing the methods in groups with GFR of 44-30 mL/min/1.73 m2 (12.1% versus 0%, χ2=28.97, p<0.05) and GFR of 29-15 mL/min/1.73 m2 (5,0 versus 0%, χ2=5.13, p<0.05). In the interval from the reduced GFR of 89-60 mL/min/1.73 m2 there was no significant difference between these methods used (51% versus 35.8%, χ2=2.95, p>0.05).

Conclusion: Systemic effects of COPD induce the development of protein-energy malnutrition and muscle loss. A close relationship between creatinine and muscle tissue condition lowers the creatinine level and results in overestimation of the real GFR and underdiagnosis of CKD in these patients.


CKD, COPD, creatinine, muscle dysfunction, cystatin C

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Turin TC, Tonelli M, Manns BJ, Ravani P, Ahmed SB, Hemmelgarn BR. Chronic kidney disease and life expectancy. Nephrol Dial Transplant. 2012;27(8):3182-6. doi: 10.1093/ndt/gfs052.

Elmahallawy II, Qora MA. Prevalence of chronic renal failure in COPD patients. Egypt J Chest Dis Tuberculosis. 2013;62(2):221-7.

Yoshizawa T, Okada K, Furuichi S, Ishiguro T, Yoshizawa A, Akahoshi T, et al. Prevalence of chronic kidney diseases in patients with chronic obstructive pulmonary disease: assessment based on glomerular filtration rate estimated from creatinine and cystatin C levels.

Int J Chron Obstruct Pulmon Dis. 2015;10:1283-9. doi: 10.2147/COPD.S80673.

Bolotova EV, Dudnikova AV. Peculiarities of renal dysfunction in patients with chronic obstructive pulmonary disease. Klin nefrol. 2015(2-3):27-32 (in Russian).

Da Silva RP, Nissim I, Brosnan ME, Brosnan JT. Creatine synthesis: hepatic metabolism of guanidinoacetate and creatine in the rat in vitro and in vivo. Am J Physiol Endocrinol Metab. 2009;296(2):E256-61. doi: 10.1152/ajpendo.90547.2008.

Ferguson MA, Waikar SS: Established and emerging markers of kidney function. Clin Chem. 2012;58(4):680-9. doi: 10.1373/clinchem.2011.167494.

Report GOLD. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. 2014. Assessed in January 2015.

Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Int Suppl. 2013;3(1):1-150. doi:

Maltais F, Decramer M, Casaburi R, Barreiro E, Burelle Y, Debigaré R, et al.; ATS/ERS Ad Hoc Committee on Limb Muscle Dysfunction in COPD. An Official American Thoracic Society/European Respiratory Society Statement: Update on Limb Muscle Dysfunction in Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med. 2014;189(9):e15-62. doi: 10.1164/rccm.201402-0373ST.

Baxmann AC, Ahmed MS, Marques NC, Menon VB, Pereira AB, Kirsztajn GM, et al. Influence of muscle mass and physical activity on serum and urinary creatinine and serum cystatin C. Clin J Am Soc Nephrol. 2008;3(2):348-54. doi: 10.2215/CJN.02870707.

Incalzi RA, Corsonello A, Pedone C, Battaglia S, Paglino G, Bellia V; Extrapulmonary Consequences of COPD in the Elderly Study Investigators. Chronic renal failure: a neglected comorbidity of COPD. Chest. 2010;137(4):831-7. doi: 10.1378/chest.09-1710.

Tsai CW, Grams ME, Inker LA, Coresh J, Selvin E. Cystatin C- and creatinine-based estimated glomerular filtration rate, vascular disease, and mortality in persons with diabetes in the U.S. Diabetes Care. 2014;37(4):1002-8. doi: 10.2337/dc13-1910.

Hillas G, Perlikos F, Tzanakis N. Acute exacerbation of COPD: is it the `stroke of the lungs`? Int J Chron Obstruct Pulmon Dis. 2016;11:1579-86. doi: 10.2147/COPD.S106160.

Chen CY, Liao KM. Chronic obstructive pulmonary disease is associated with risk of chronic kidney disease: A nationwide case-cohort study. Sci Rep. 2016;6:25855. doi: 10.1038/srep25855.

Mapel D. Renal and hepatobiliary dysfunction in chronic obstructive pulmonary disease. Curr Opin Pulm Med. 2014;20(2):186-93. doi: 10.1097/MCP.0000000000000024.

Mapel DW, Marton JP. Prevalence of renal and hepatobiliary disease, laboratory abnormalities, and potentially toxic medication exposures among persons with COPD. Int J Chron Obstruct Pulmon Dis. 2013;8:127-34. doi: 10.2147/COPD.S40123.



About The Authors

Elena Bolotova
"Kuban State Medical University" of the Ministry of Healthcare of the Russian Federation

Department of therapy –1, State Budgetary educational institution of higher professional education

Anna Dudnikova
Regional clinical hospital –2
Russian Federation


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