CKD VD Research Articles

COVID-19 in patients with chronic kidney disease stage 5

The study aimed to determine the frequency of COVID-19, specific of process and the mortality rate among dialysis patients with COVID-19.
 Materials and methods: The retrospective study included 764 patients with CKD VD, who received dialysis treatment at the Kyiv City Center for Nephrology and Dialysis, which is the clinical base of the Institute of Nephrology of the National Academy of Medical Sciences since September 1, 2020. until December 31, 2020. 155 patients were diagnosed with coronavirus disease. The study was conducted in two stages. In the first stage, dialysis patients with coronavirus disease were divided into groups depending on the severity of the disease.
 The second stage of the study was determined the influence of age, duration of dialysis treatment, gender, cause of chronic kidney disease VD, obesity, diabetes mellitus and cardiovascular pathology on the course of coronavirus disease, as well as complications and mortality from COVID-19 among the dialysis population.
 Results: 155 cases of COVID-19 were registered among 764 dialysis patients. Mild coronavirus disease was diagnosed in 38 (24.5%) patients, moderate and severe in 64 (41.3%) and 53 (34.2%) patients, respectively. Oxygen support was required for 76 patients (79%), and artificial lung ventilation was used for 17 (10.9%) patients. Factors associated with severe coronavirus disease in this category of patients were found to be obesity (BMI> 30 kg / m2), diabetes mellitus, concomitant cardiovascular disease, and the need for oxygen support. In this category of patients, obesity (BMI>30 kg/m2), cardiovascular disease, diabetes mellitus and require supplement oxygen are associated with severe Coronavirus disease COVID-19. There was no significant effect on the severity of coronavirus disease in the age of patients and duration of dialysis treatment. The duration of treatment in patients with diabetes was significantly higher (p <0.05), a direct strong correlation between BMI and duration of treatment was demonstrated.
 Survival was significantly higher in the group of patients who did not require oxygen support (78% vs. 56%) and had a BMI <30 kg / m2 (87% vs. 37%).
 Conclusions: the incidence of coronavirus disease among the dialysis cohort was 20.2% of cases. Patients treated with peritoneal dialysis had a significantly lower incidence. Severe coronavirus disease has been associated with obesity, cardiovascular disease, and the need for oxygen support. Men were more likely to have COVID-19 than women. There is no connection between the severe course of coronavirus disease with the age of patients and the duration of dialysis treatment. The duration of treatment of Coronavirus disease in the group of patients with diabetes and high BMI was longer. The following complications predominated in patients with COVID-19: thrombosis of arteriovenous fistula and atrial fibrillation. 
 During the study period, 20 (12.9%) deaths were registered. Patient survival was higher in the group of patients without oxygen support and with a lower BMI.

The state of hemostasis in patients with CKD VD stage with some comorbid conditions

Annotation. Clinical observations indicate that one of the rather important mechanisms in the pathogenesis of complications in CKD stage VD are disorders in the hemostatic system leading to the development of thrombophilia. Comorbidity in this category of patients significantly worsens the prognosis due to the potentiation of hypercoagulation, which, as a comorbid syndrome, accelerates morphological changes in the kidneys, contributes to the deposition of fibrin in the glomeruli and the development of thrombosis. The aim of the study was to study the indices of the main links of hemostasis depending on some comorbid conditions (acute inflammation, secondary hyperparathyroidism, hepatitis B and C). The study involved 52 men and 36 women with CKD stage VD, who were on programmed hemodialysis, in whom the levels of soluble fibrin, D-dimer, fibrinogen, protein C, indicators of hemostatic potential in these comorbid conditions were determined. Statistical processing of materials was performed using the methods of variation statistics.It was determined that the presence of a fast phase of inflammation enhances the processes of hypercoagulability, and a high level of parathyroid hormone (˃800 pg/ml) in combination with hyperphosphoremia slightly increases the level of fibrinogen. Infection with hepatitis C significantly increases the level of soluble fibrin, and infection with hepatitis B decreases the level of protein C. The study and implementation of a comprehensive assessment of the state of hemostasis in patients with CKD stage VD complicated by comorbid diseases makes it possible to identify imbalances in the pro- and anticoagulation system.

HYPERPROLACTINEMIA AND ANEMIA IN HEMODIALYSIS PATIENTS

Aims: To determine the relationship of prolactin (PL) levels with the frequency of anemia and the level of cardiovascular events in patients with CKD VD stage.Material and methods: A prospective cohort study included 55 patients with CKD VD stage with anemia. Serum prolactin levels were determined in all patients.Results and discussion: 24 patients (44%) had normal levels of PL, and 31 (56%) patients had elevated levels of PL. It was determined that PL had a negative correlation with hemoglobin level (r = -0.42; p = 0.01), as well as a negative correlation with albumin level (r = -0.38; p = 0.02). The frequency of cardiovascular events after 12 months. In patients with elevated levels of PL was significantly higher than in patients with normal levels of PL: 17 events (55%) vs 4 events (17%) (χ2 8.4, p = 0.004).Conclusions: The prevalence of hyperprolactinemia in our study was 56%. Elevated levels of PL are associated with lower levels of hemoglobin, lower levels of albumin and an increased frequency of cardiovascular events.

Structural and functional changes of the heart in patients with diabetic nephropathy undergoing hemodialysis

Systematic analysis of cardiac remodeling peculiarities in patients with V D stage of chronic kidney disease (CKD VD) caused by diabetes mellitus is important both in the stratification of cardiovascular risk and in the choice of adequate treatment strategies.
 The purpose of the study was to determine the character of structural and functional reconstruction of myocardium in patients with diabetic nephropathy (DN) on maintenance hemodialysis (HD) by identifying left ventricular hypertrophy (LVH), its geometric types, assessment of the severity of heart dysfunction, pulmonary hypertension (PH), as well as determination of frequency of cardiac valve calcification (CVC), development of defects of mitral (MV) and aortic (AV) valves.
 Materials and methods. The study included 136 patients on chronic HD (men, 78, age, (53,9±1,0) years, duration of HD, (47,6±4,2) months). Depending on the presence/absence of type 2 diabetes mellitus (DM) with kidney damage, they were divided into two groups: the first one – without DN (n=88); the second one – with DN (n=48). All patients were followed up by standard echocardiography (EchoCG) examination by standard procedure.
 Results. LVH was diagnosed in 84.6% of patients with CKD VD stage, significantly more often (93.8 vs. 78.4%, p=0.020) in patients with DN, with the incidence of eccentric LVH in the second group being higher (47.9 vs. 28.4%, p=0.023) than in the first one. Prevalence of pseudonormal and restrictive types of LV diastolic dysfunction (62.5 vs. 28.4%, p<0.001), LV systolic dysfunction (27.1 vs. 9.1%, p=0.006) and PH (64.6 vs 35.2%, p=0.001) were significant in HD patients with DN. CVC was detected in 66.6% of patients with type 2 DM with renal injury with a predominance of calcification of both valves (35.4%) over isolated calcification of MV (MVC) (20.8%) and AV (AVC) (10.4 %). Combined valve calcification in the HD patients of the second group was observed 2.6 times more often (p=0.003) than in the first one. Patients with DN, unlike those without diabetes, were associated with a higher prevalence of stenoses of MV (16.7 vs. 3.4%, p=0.007) and AV (39.6 vs. 15.9%, p=0.004), and insufficiency of MV (66.7 vs. 44.3%, p=0.013) and AV (35.4 vs. 14.8%, p=0.006). The most significant EchoCG parameters that distinguished groups of HD patients with the presence of DN were: left atrial diameter (p<0.001), end-diastolic LV dimension (p<0.001), thickness of interventricular septum (p=0.001), LV myocardial mass index (p=0.001), ratio of transmitral flows in early and late diastole (p=0.009), time of deceleration of early diastolic transmitral blood flow (p<0.001), LV ejection fraction (p=0.009), diameter of the right ventricle (RV) (p=0.003), diameter (p=0.007) and mean pulmonary artery pressure (p<0.001).
 Conclusions. In patients with CKD VD stage with DN the maladaptive cardiac remodeling with predominance of unfavorable types (eccentric (to a greater extent) and concentric) LV hypertrophy, RV dilatation, PH, expressive of LV diastolic and systolic dysfunction, large-scale combined MVC and AVC occurs, which, in turn, leads to the formation of valve defects, can contribute to the progression of diastolic myocardial stiffness and heart failure.

Impact of hydrating status on residual renal function in hemodialysis patients (first report)

Residual kidney function (RKF) is a powerful indicator of residual renal functional capacity that eliminates uremic toxins and fluid in hemodialysis patients.
 The purpose of our study was to investigate the influence of hydrating status on residual renal function in patients with CKD 5HD.
 Methods. A prospective observational study included 60 hemodialysis patients with CKD VD. All patients were examined - taken general and biochemical blood tests, determined the level of urea and creatinine in the daily urine. RKF was evaluated by urine volume, residual KT / V and KRU. Water balance was measured and evaluated using BCM-monitor.
 Results.During the analysis of BCM data, hyperhydration (OH / ECW above 15%) was revealed in 15 among all patients included in the study, which amounted to 25%. A statistically significant difference between patients who were hyperhydrated and normohydrated was found in relative (OH / ECW) and absolute hydration (OH), ECW, and ultrafiltration rates. Thus, in the group of hyperhydrated patients, the average relative hydration rate was 14.3% lower compared to normohydrated patients (p < 0.001) and absolute hydration by 2.6 l (p < 0.001).
 In further analysis, no significant difference between two groups was found in the indicators characterizing the RKF, namely, between the level of urine output, KRU, KT / Vren. The level of ultrafiltration in the group with normal hydration is 900 ml lower than that with hyperhydration (p < 0.005). In study the influence of indicators of hydration status such as OH, OH / ECW, TBW, ECW, ICW on RKF indices no reliable correlation of the above mentioned values ​​with diuresis, KRU, KT / Vren (p > 0.05) was found. A positive correlation was found between KRU, diuresis and KT / Vren, indicating that with increasing diuresis the KRU value and KT / Vren increase (p < 0.001). The same relationship was found between diuresis and KT / Vren, p < 0.001. An analysis of the relationship between absolute and relative hydration with dialysis efficacy (eKT / V) revealed that dialysis efficacy decreases with increase of hydratation in CKD 5HD patients (p < 0.05).
 Conclusions. The results obtained in our study indicate that the indicators of hydration status at baseline do not allow to find out an influence of them on the baseline level of RKF (diuresis, KRU and KT / Vren) in patients with CKD 5HD. Issues of the influence of hydration status on changes in RKF during the observation will be addressed in the following reports.

MON-195 TO STUDY CORRELATION OF NAIL CREATININE WITH SERUM CREATININE IN CHRONIC KIDNEY DISEASE STAGE Vd & IN RENAL TRANPLANT RECIPIENT.

Kidney disease is a global health problem. According to the World Health Organization, approximately 850,000 patients develop End Stage Kidney Disease (ESKD) every year. It was postulated that the concentration of creatinine in fingernail and toenail clippings might be of value in distinguishing acute from chronic azotemia. As there are very few studies done based on this hypothesis, we conducted the study to find out whether fingernail creatinine can correlate with serum creatinine in chronic kidney disease and to identify the change in finger nail concentration with enhancing renal function after renal transplant. OBJECTIVE: - To assess nail creatinine in relation with serum creatinine in patients with Chronic Kidney Disease on hemodialysis and to study its profile in patients who have undergone kidney transplant. A prospective, observational cohort study conducted at tertiary health care centre, 20 patients were selected for the study. Out of which 10 patients were diagnosed as chronic Kidney disease (CKD Vd) with more than 30 days of dialysis vintage, 10 CKD patients who underwent kidney transplant were followed-up for three months post transplant. 10 healthy volunteers were included in the study as controls. The Nail creatinine was extracted in water first by pulverization, followed by mechanical powdering. Sample powder incubated at 45°C for 2 hrs, centrifuged and then assayed by Alkaline Picrate-method on semi Auto Biochemistry Analyzer (Robonik). In our study, control group had mean serum creatinine of 0.78 ± 0.13 mg/dl and nail creatinine of 33.99±4.55 µg/g; while the mean of serum creatinine was 9.56±4.19 mg/dl and nail creatinine was 90.05±19.72 µg/g in CKD Vd group. In Post renal transplant patients, the serum creatinine on the day of transplant [Month (M) 0] was 9.07±1.62 mg/dl and on three month (M1, M2, M3) follow-up, the serum creatinine were 1.41±0.31mg/dl, 1.31±0.37mg/dl, 1.31±0.33mg/dl respectively. The nail creatinine on the day of transplant (M 0) was 85.01±23.66 µg/g and on serial measurements for three month (M1, M2, M3) the nail creatinine levels were 61.58±15.93µg/g, 44.66±8.95µg/g, 41.16±15.56µg/g respectively. We found that, nail creatinine levels in CKD Vd group was higher than Control groups (p-value 0.001). Though nail creatinine levels in patients who underwent renal transplant were similar to those in CKD Vd patients initially, nail creatinine level gradually reduced and reached values comparable to that of control group. Hence, nail creatinine correlate with serum creatinine level in patients with chronic kidney disease.

Impact of hemodialysis on the state of water compartments in CKD VD patients

Understanding of changes in water compartments during hemodialysis (HD) is an important part of ensuring the effectiveness of the procedure and minimizing both intra- and post-dialysis complications.
 The purpose of our study was to investigate the direction of changes in water sectors in patients with CKD 5D with preserved residual kidney function (RKF) and without RKF.
 Methods. Prospective observational study enrolled 88 hemodialysis (HD) patients. All patients performed laboratory examinations and measurements of water balance using the BCM monitor before HD, hourly after the start, and 30 minutes after the end of the session. Depending on the presence of residual kidney function, patients were divided into two groups. The first group with RKF included 52 patients, the second - without RKF - 36.
 Results. Analysis of water balance parameters allowed to conclude that 26 patients (26.13%) were hyperhydrated (OH/ECW above 15%), including 13 (36,11%) in the group without RKF and 10 (19,2%) - in the group with the preserved RKF. There was no statistically significant difference in the groups. When comparing baseline values between groups of patients, it was found that in the group with preserved RKF the albumin level was significantly higher at 8.94% (p<0.05), levels of phosphorus and potassium were lower by 18.27% and 20.24%, respectively. There was no statistically significant difference between other clinical parameters in the groups. Subsequent analysis of the water balance indicators allowed establishing a reliable positive correlation between the level of ultrafiltration (UV) and total body water (TBW). The higher the UV level, the higher the ECW (p < 0.05). Similar results were obtained when analyzing the relationship between extracellular fluid (ECW) and UV (p < 0,001). As a result of the correlation analysis between the level of UV and diuresis, the mean inverse correlation relationship is shown, which shows - the lower the diuresis, the higher the level of ultrafiltration (p < 0,001). During HD the TBW (ΔTBW = 1.5 ± 1.8) and ECW (ΔECW = 1.92 ± 0.85) progressively decrease, the ICW compartment is practically unchanged (ΔICW = -0.17 ± 0.89). In patients with preserved RKF the change in ECW is significantly lower comparatively with the group without RKF (p <0.05).
 Conclusions. Obtained data indicate that the clinical evaluation of hyperhydration is not always adequate. The obtained results confirm the fact that the presence of RKF provides better phosphorus and potassium levels control in patients with CKD. During HD the removal of fluid occurs directly from the extracellular space, in the group with the RKF to a lesser extent, indicating that the presence of diuresis provides a lower volume of OH, TBW, ECW before HD session, and therefore the level of ultrafiltration appears to be less. Thus the RKF also provides better control of water balance. The results of the dynamics of water sector changes during HD can be used to assess the refilling in the future.

Pneumonia in patients with chronic kidney disease V D stage: pathogenetic aspects of complex therapy and outcomes

Abstract.The aim of our study was to increase the effectiveness of treatment of comorbid pneumonia in patients with CKD VD stage.
 Materials and Methods. 73 patients with CKD VD st. (59 on HD and 14 on PD) with mild to moderate comorbid pneumonia who received renal replacement therapy (RRT) during 2013-2016 were included in the observational prospective open-label randomized trial. Patients were randomized into two groups: group 1 (n = 42) included patients who in addition to the conventional therapy of pneumonia received medication «Lipin» as a complex therapy; group 2 included patients (n = 31) who received only basic (traditional) therapy. The groups were representative by the main demographic, social and clinical-laboratory findings, severity of pneumonia, duration and modality of RRT. The primary endpoints were death from any cause and episodes of rehospitalization. The overall assessment of the clinical efficacy of the therapy was based on a comparison of the duration of hospitalization, antibiotic therapy, intoxication syndrome, and regression of X-ray changes.
 Survival in observation groups was determined by the Kaplan-Meier method. Analyzed cases were included to October 31, 2018.
 The markers of oxidative stress (OS) were determined in 29 patients of group 1 and 14 patients of group 2 before treatment and after 14 days while treatment of pneumonia was started.
 Results. The analysis demonstrated that during a 1-year period a 17 (25,76%) episodes of rehospitalization were recorded: 11 causes (35.5%) in group 1 and 6 (14.3%) in group 2 (χ² = 4.486, p = 0.035). In total, 29 deaths were recorded during the study period: 10 (23.8%) cases in group 1, and 19 (61.3%) - in group 2 (χ² = 8.957, p = 0.003, RR - 2.574, 95% CI: 1.400-4.733). The three- and five-year cumulative survival rates were 83% vs. 21% and 59% vs. 21%, in the group 1 and group 2, respectively (p = 0.00003). It was stated that the duration of hospitalization, antibiotic therapy, intoxication syndrome and X-ray regression were significantly lower in group 1 compared with group 2 (p <0.05). The comparative analysis of dynamics in the groups shows that increasing the treatment effectiveness at complex therapy background accompanied by a significant positive dynamics of OS markers (p <0,05).
 Conclusions Thus, the results of this study demonstrated the effectiveness of complex method of pneumonia treatment in patients with CKD stage 5D including Lipin medication compared traditional therapy. There is a significant difference in patient survival depending on the proposed and generally accepted treatment.

The evaluation of residual kidney function in patients with ckd vd and approaches of its preservation

The work is a literature review. Residual kidney function (RKF) is one of the crucial indicators of mortality and quality of life in patients with chronic kidney disease. Residual renal function provides better control of hydration, blood pressure, clearance of substances with low and middleweight, anemia, Ca/P metabolism, chronic inflammation. However, approaches to preservation of RKF in dialysis patients have been studied not enough, the importance of RKF preservation is underlined. The wide range of predictors of RKF loss are presented in the article, approaches to measurement of RKF, the relationship between level and presence of RKF with survival and mortality of patients with CKD 5D were analyzed. The possibility of RKF preservation and extension using different approaches by correction of dialysis prescription were estimated. There is no standardized method for applying incremental hemodialysis in practice. Onceto twice-weekly hemodialysis regimens are often used randomly, without knowing the benefit for current patient or how to escalate the dialysis dose if RKF declines over time. It is important to change the HD/HDF prescription according to the range of RRF using objective data.

COMORBIDITY AND SURVIVAL OF PATIENTS WITH CHRONIC KIDNEY DISEAS STAGE 5 D

Annual expansion of dialysis population, high mortality, considerable expenses on specialized medical care are evoked the medical community to research comorbidities, that undoubtedly has an influence on course of chronic kidney disease VD stage (CKD VD st.) and prognosis.
 Aim. The aim of this study was to investigate the prevalence and structure of comorbid conditions in patients with CKDVD stage, and determinate the relation between comorbidities and survival rate in dialysis population.
 Materials and methods. It was studied the prevalence and structure of comorbidities among 204 patients with CKD VD st. (125 on hemodialysis [HD], 51 on peritoneal dialysis [PD], and 28 on hemodiafiltration [HDF]). All recorded concomitant diseases with its incidence data and coand polymorbidity indices were analyzed in consideration of renal replacement therapy (RRT). The survival rates were assessed in according with indices of comorbidity by Kaplan - Mayer methodology.
 Results. The performed analysis was demonstrated that in almost single patient had no mononosologicalpathology. The numbers of concomitant diseases were 3,55, 3,3 и 3,4 3,3per patient on HD, HDF and PD, respectively, without significant relation with RRT modality. In according with the study results the most common comorbid conditions, irrespective from RRT modality, were anaemia (88%), arterial hypertension (86%), and secondary hyperparathyroidism (40%). The proposed modified index of polymorbidities was revealed as the universal marker of survival rate in patients with CKD VD st.
 Conclusion. Thus the considerable prevalence of comorbid conditions in population ofpatients with CKD VD st. irrespective of RRT modality has significant negative effect on prognosis.

CARRIAGE OF OPPORTUNISTIC MICROORGANISMS AND SURVIVAL OF PATIENTS WITH CHRONIC KIDNEY DISEASE STAGE 5 D

Despite of significant development of dialysis technology, mortality rates of CKD V D stage patients remain unsatisfactorily high. Next to cardiovascular diseases, infections are seems to be as a major causes of morbidity, hospitalization and mortality in this population. Staphylococcus aureus, especially MRSA, infections are a major cause of morbidity and hospitalization in CKD V D stage patients. Preceding MRSA colonization views as a risk factor for subsequent MRSA infections in future.
 Aim. The aim of this study was to explore the effects of opportunistic pathogens colonization on survival in patients with CKD VD stage.
 Materials and methods. This prospective cohort, open-label study included 255patients with CKD V D st. (198 HD and 57 PD patients). Patients were randomized into two groups, depending on the MRSA colonization history: first group (n=66) included patients with identified MRSA colonization and the second group (n=189) included patients with colonization of other opportunistic pathogens. The groups were representative according to gender, age, type of kidney affections and renal replacement therapy (RRT) modality. The endpoint was the total number of deaths. All cases, which took place from 01.08.2011 to 01.08.2016 year, were analyzed. The Kaplan-Meier method was perfomed for evaluation of survival.
 
 Results. The analysis allowed to state that during analyzed period in total were 75 deaths: in the first group ofpatients - 32 (48.5%), and in the second - 43 (22.8%) cases; %2= 14,38, p = 0,000078; RR – 2,131, 95% ffl: 1,484-3,060.
 The survival rate of patients was significantly lower in the first group, irrespective of RRT modality. The 3-years cumulative proportion surviving was 53% and 79% in the first (MRSApositive) and second groups, respectively; p< 0,001.
 Conclusion. This study demonstrated that MRSA asymptomatic colonization has a significant negative effect on survival in the patient population with CKD VD stage

VASCULAR ACCESS OPTIONS AT HEMODIALYSIS THERAPY INITIATION: COMPLICATIONS AND SURVIVAL OF PATIENTS WITH CHRONIC KIDNEY DISEAS STAGE 5 D

The annual increasing of dialysis population results tofocus world attention on the problems associated with improving of survival among patients with chronic kidney disease stage VD (CKD VD st.)., decreasing iatrogenic complicationfrequency. HD is the most common method ofrenal replacement therapy (RRT). Several studies haveproven the link between the type ofinitial vascular access, and an morbidity and survival of patients with CKD VD st..
 Aim. The aim of this study was to explore the effects of an initial vascular access on morbidity and survival inpatients with CKD VD st., which are treated with hemodialysis.
 Materials and methods. In the study 79HDpatients were included. Patients were randomized into twogroups, depending on the type of vascular access at the start of HD treatment: the first group (n = 47) included patients, who started HD treatment through theformed AVF, patients among which central venous catheter (CVC) was usedfor the HD initiation composed the second (n= 32) group.
 The endpoints were: the total number of deaths, hospitalizations due to bacterial infections, sepsis, unstable angina and myocardial infarction. All cases that took place from 01.01.2013 to 01.12.2015 year were analyzed. Evaluation of survival wasperformed using the Kaplan-Meier method.
 Results. The analysis allowed to state that during analyzed period in total were 24 deaths: in the first group ofpatients - 10 (21.28%), and in the second - 14 (43.75%) cases; p = 0.03299. The survival rate ofpatients was significantly lower with the CVC. The 10-years cumulative proportion surviving was 73% and 40% when using of AMT and CVC, respectively. The relative risks and odds ratio for all-cause hospitalization in the second group ofpatients (26 episodes) were significantly higher compared to thefirstgroup (16 cases): RR = 2,387, (95% Cl: 1,550-3,674) and OR = 8,396 (95% Cl: 2,870-24,559). It was established a significant increasing of the hospitalization incidences both due infectious comorbidity (9/21,43% versus 15/46,9%;p = 0,0085), and cardiovascular diseases (7/16.7% vs. 11/34,37%;p = 0,0427) inpatients with a history ofthe CVC use at the HD initiation, compared withpatients who started treatment through theformed AVF.
 Conclusion. Thus, the obtainedfindings suggest that the use of the CVC at the HD initiation has a significant negative effect onprognosis in thepatientpopulation with CKD stage VD.

OXIDATIVE STRESS AND RESISTANCE OF ERYTHROCYTES MEMBRANES IN PATIENTS WITH CHRONIC KIDNEY DISEASE STAGE VD DEPENDING ON MODALITY OF RENAL REPLACEMENT THERAPY

The aim of the research was to study the effect ofoxidative factors impact and modality of renal replacement therapy (BBT) on indices ofoxidative stress (OS) and resistance of erythrocytes membranes in patients with chronic kidney disease stage V(CKD VD) and anemie.
 Material and methods. The study involved 68 patients with CKD VD: 14 patients were treated by hemodiafiltration (HDF), 25 patients by hemodialysis (HD) and 29 patients by peritoneal dialysis (PD). The severity ofanemia was assessed according to the KDIGO (2012) criteria. The control group consisted of 30 healthy people of the same age and sex. Along with the standard diagnostic methods, we defined the content of malonic dialdehyde in serum (MDAs) and in erythrocytes (MDAe), the content of ceruloplasmin (CPs), transferrin (TBs) and SH-groups in the blood serum, the index of the OS (IOS), catalase activity in serum (CATs), glucose-6-phosphate dehydrogenase (G-6-PDHe) and total peroxidase activity (TPA) in erythrocyte, peroxide resistance (PR) of red blood cells and erythrocyte membrane permeability (EMP). Statistical analysis was performed using the programs of Microsoft Excel 7.0.
 Results. It has been stated that in the CKD VD patients in compatison with control group the MDAs content increased by 3.3 times and MDAe - 1.2 times, TBs content reduced by 34%, SH-groups - by 31%, TPAe - by 41% and G- 6-FDGe - by 58%, PB-by 60%; 4.6 times increased CATs activity and OSI; 2 times grew peroxide hemolysis (PH) and 1.3 times - EMP. The analysis (depending on the BBT modality) showed that the patients treated by HDF had typical MDAs increase by 3.9 times on a background of CPs by 24%, TBs - 33%, SH-groups - 25%, TPAe - 51%, G-6-PDHe - 42%; the increase in serum OSI - 5.4 times and 2.6 times in erythrocytes, PB - by 3.6 times and CATs activity by 3.5 times; HD group was characterized by the highest value of MDAe, OSI, PH and CATs, along with more expressed decrease of TBs indices, SH-groups, TPA and G-6-FDHe activity compared with rates in patients with HDF. The patients treated with PD had the lowest content of MDAs and the highest values on the background ofTPAe, the significant increase of CPs by 1.7 times and lowest TBs and G-6-PDHe. The patients with PD showed twice lower OS activity by OSI.
 Conclusion. Thus, in patients with CKD VD, who had HD, HDF or PD an anemie was associated with high OS activity and the increased degree of hemolysis. These changes are stipulated by BBT methods: for patients receiving HDF were typical the lowest rates of hemolysis and the highest degree ofprotection for erythrocytes, and for patients treated with HD - the highest OS.

CORRECTION OF IRON DEFICIENCY IN CKD V HD PATIENTS WITH ANEMIA

Hemodialysys results in loss of15-20 ml of blood or 5-7 mg of iron during each session or at least 1 g/ year. Additional iron may be lost through the gastrointestinal tract and during the menstruation in women. Excluding others possible reasons (genitourinary issues, laboratory investigations iron losses can amount minimum 1.7g per year). Dietary iron intake (0.5 – 1.0 g/year) only partially offsets iron deficit.
 According to KDOQI Anemia Guidelines (2006), “the average iv iron needed to maintain a stable serum ferritin (SF) level and in that way neutral iron balance, appears to be range 22-65 mg/week; this amount corresponds with SFl > 200 mg/ at but the same time there is no sufficient evidence to recommend routine administration of iron if SF > 500 mg/l.
 KDIGO Guidelines (2012) do not recommend routine use of iron supplementation in patients with transferrin saturation (TSAT) > 30% and SF > 500 mg/1.
 Thereby the target SF and TSAT levels in CKD VD patients remain controversial and in practice are determined by specific clinical tasks requiring resolution: to increase hemoglobin level without erythropoiesis stimulating agents (ESA) administration, or to decrease ESA dose in its turn depends on specific patient’s iron status (absolute or functional iron deficit) and treatment period, – predialysis or dialysis.

INDICATORS OF OXIDATIVE STRESS AND RESISTANCE OF ERYTHROCYTES IN PATIENTS WITH CHRONIC KIDNEY DISEASE STAGE VD DEPENDING ON MODALITY OF RENAL REPLACEMENT THERAPY

The object was to study the effect of oxidative factors and methods of renal replacement therapy (RRT) on indices of oxidative stress (OS) and resistance cells in blood in patients with chronic kidney disease stage V(CKD VD) and anemic syndrome.
 Material and methods. The study involved 47 patients with CKD VD: 14patients were treated by hemodiafiltration (HDF), 14 patients by hemodialysis (HD) and 19 patients by peritoneal dialysis (PD). The severity ofanemia was assessed according to the KDIGO (2012) criteria. The control group consisted of30 healthy people of the same age and sex. Along with the standard diagnostic methods, we defined the content of malonic dialdehyde in serum (MDAs) and in erythrocytes (MDAe), the content of ceruloplasmin (CPs), transferrin (TRs) and SH - groups in the blood serum, the index of the OS (IOS), catalase activity in serum (CTs), glucose - 6 - phosphate dehydrogenase (G - 6 - PDHe) and total peroxidase activity (TPA) in erythrocyte, osmotic (OR) and peroxide resistance (PR) of red blood cells and erythrocyte membrane permeability (EMP). Statistical analysis was performed using the programs Microsoft Excel 5,0 and MedStat.
 Results. It has been stated that in the CKD VD patients agains the rates in control group the MDAs content increased by 3.3 times and MDAe - 1.2 times, TRs content reduced by 34%, SH - groups - by 31%, TPAe - by 41% and G - 6 - FDGe - by 58%, marcers of OR by 30%, PR - by 60%; 4.6 times increased CTs activity and OSI; 2 times grew peroxide hemolysis (PH) and 1.3 times - EMP. The analysis (depending on the RRT modality) showed that the patients treated by HDF had typical MDAs increase by 3.9 times on a background of CPs by 24%o, TRs - 33%, SH - groups - 25%, TPAe - 51%, G6 - PDHe - 42%; the increase in serum OSI - 5.4 times and 2.6 times in erythrocytes, PR - by 3.6 times and CTs activity by 3,5 times; HD group were characterized by the highest value of MDAe, OSI, PH and CTs, along with more expressed decrease of indices TRs, SH - groups, TPA and G - 6 - FDHe activity compared with rates in patients with HDF. The patients treated with PD had the lowest content of MDAs and the highest values on the background ofTPAe, the significant increase of CPs by 1.7 times and lowest TRs and G - 6 - PDHe. The patients with PD showed twice lower OS activity by OSI.
 Conclusion.Thus, in patients with CKD VD, who had HD, HDF or PD an anemic syndrome was associated with high OS activity and the increased degree of hemolysis. These changes are stipulated by RRT methods: for patients receiving HDF were typical the lowest rates of hemolysis and the highest degree of protection for erythrocytes, and for patients treated with HD - the highest OS.

ANTIMICROBIAL RESISTANCE OF GRAM POSITIVE BACTERIA ISOLATED LNPATLENTS WLTHCHRONLCKLDNEYDLSEASSTAGE5D: PREVALENCE AND OUTCOMES

Bacterial infections in chronic kidney disease stage VD (CKD VD st.)patients are associated with increased risk of hospitalization and death.
 
 The aim was to study of opportunistic pathogenic bacteria spectrum, their antibacterial resistance and the correlation between carriage and hospitalization and mortality rate in adult patients with CKD V D st.
 Materials and methods. This prospective cohort, open-label, randomized, two-phase study included 146 patients with CKD V D st., 118 of whom were treated by hemodialysis (HD) and 28 by peritoneal dialysis (PD). The microbiological screening was conducted in the first stage. The examined material was throat/nose swabs and wet smears from skin of dialysis access site. On the second stage all patients were randomized on two groups: the group 1 (n=61) included patients with identified MRSA / VRE colonization and group 2 (n=85) included patients with colonization of other strains of opportunistic pathogenic bacteria. The groups were representative according to gender, age, type of kidney affections and renal replacement therapy (RRT) modality. The microbiological examination consisted of inoculation of hard medium by examined material. The end points were total amount of hospitalization and death events evaluated for 24 months after randomization.
 Results. The colonization of some biotype of opportunistic pathogenic bacteria was established in 100% ofpatients. In total were isolated 347 strains of gram-positive bacteria: 284 and 63 in HD and PD patients, respectively. Without statistical significance approximately 20% of microorganism strains were resistant to 10 and more antibiotics according to dialysis modality. The MRSA colonization was identified in 49 (33.6%) patients (37/31.4% and 12/42.9% of HD u PD patients, respectively; p=0,246). The VRE colonization was established in 12 patients (10/8.5% and 2/7.1% of HD and PD patients, respectively; p=0.81).
 The 70 hospitalization episodes were recorded during monitoring period. The significant majority was established in group 1 of patients (39/64% vs. 31/36.5 %; %2 =10.733, p=0,001) irrespective ofRRTmodality. The specific share ofdead persons in group 1 was in three times more than such share in group 2 (9/14.8% vs. 4/4.7 %; %2=4.42, p= 0.0355). The relative risks of hospitalization and death in the presence of MRSA/VRE colonization increased in 1.75 (95% CI: 1.252.5) and 3.14(95% CI: 1.01-9.7) times.
 Conclusion. In this study was demonstrated that MRSA/VRE colonization in adult patients with CKD V D st. is a risk marker and a predictor of negative clinical prognosis. The RRT modality hadn’t significant effect on rate of negative consequences, particularly on rate of hospitalization and death in population of CKD V D st. patients.