According to the newest data of Polish Diabetes Association about 6% of the Polish population suffer from diabetes. This number has increased by 2 percentage points over the last decade. Diabetes is the main risk factor for ischaemic heart disease, renal insufficiency, stroke, sight loss and the main reason for lower extremities amputation. It reduces life span by 5-10 years (1, 2). Diabetes is concerned as a group of metabolic disorders with one common factor – hyperglycemia (3). Hyperglycemia leads to microangiopathies (retinopathy, nephropathy) and macroangiopathies. Diabetes is based upon autoimmunological processes leading to the destruction of β cells of the Langerhans islets with the participation of autoantibodies to islet cells (ICA), antibodies to insulin (IAA), and glutamic acid decarboxylase autoantibodies (GAD). Other factors predisposing to the development of autoimmunological processes are viral infections (viruses: rubella, CMV infection, Coxackie B4), short period of breastfeeding, administration of nitrites, stress. The main cause of diabetes is impaired tissue sensitivity to insulin. Age, lipid disorders, hypertension are risk factors for diabetes. Diabetes of known aethiology includes genetic disorders of the pancreatic β cells (MODY), exocrine pancreatic diseases such as acute and chronic pancreatitis, pancreatectomy, pancreatic cancer and cystic fibrosis (4, 5). Diabetic nephropathy in diabetic patients is defined as chronic kidney disease in the absence of non-diabetic background. Around 40% of diabetic patients are particularly prone to renal complications. These are either GFR < 60 ml/min/1.73 m² for more than 3 months and/or structural kidney disorders. Diabetic nephropathy comprises 5 stages depending on the glomerular filtration rates corresponding with chronic kidney disease. Stages of the chronic kidney disease correlate with glomerular filtration rates in the following way: stage 1 – GFR > 90 ml/min with albuminuria, stage 2 – GFR 90-60 ml/min with albuminuria and latent kidney disease, stage 3 – GFR 60-30 ml/min compensated chronic kidney disease, stage 4 – GFR 30-15 ml/min non-compensated chronic kidney disease, stage 5 – GFR < 15 ml/min defines uraemia (6, 7).

Pacemaker protects from life-threatening arrhythmias such as bradyarrhythmias. Since fifty years it has enabled ensuring imposed heart rate supporting synchronous work of cardiac muscle (8). The indications for pacemakers include cardiac muscle diseases and disorders which lead to secondary dysfunction of electrical conduction system of the heart. Chronic kidney disease intensifies arteriosclerosis and influences the prevalence of cardiovascular complications, e.g. bradyarrhythmias. The aim of the study was the assessment of renal function in patients with bradyarrhythmias and coexisting diabetes before pacemaker implantation and 24 and 48 hours after the procedure.

92 patients (45 women and 47 men) with arrhythmias and indications for permanent pacing treated in the Departament of Cardiology of the J. Śniadecki Regional Specialist Hospital in Białystok were enrolled in the study. Each patient was examined before the procedure of pacemaker implantation. 60 patients had DDD pacemaker, 2 patients had VDD pacemaker and 30 patients had VVI pacemaker. Before the procedure patients had GFR calculated with MDRD equation. Renal assessment was repeated after 24 and 48 hours. Glomerular filtration rates were calculated with simplified MDRD equation (modification of diet in renal disease) (9) which comprised serum creatinine concentration, age and gender (10, 11). The precision of MDRD results increased with age in patients with diabetes, in men (in comparison to women), and in slim patients (12).