Stages Of Chronic Renal Failure Research Articles

The initial experience of robot-assisted nephron-sparing surgery in patients with renal cell cancer

Purpose of the study: analysis of our experience in performing robotic-assisted nephron-sparing surgeries using the da robotic system. Material and Methods. The retrospective study included the first 37 consecutive patients who underwent robot-assisted partial nephrectomy from May 2020 to december 2022. Results. To assess the surgical outcomes in patients undergoing partial nephrectomy, three parameters associated with trifecta achievement were analyzed. The trifecta was assessed according to the standard criteria, whereas the quadfecta, which in addition to the trifecta included preservation of >90 % of the glomerular filtration rate (calculated according to Cockroft–Gault) in the postoperative period (3–7 days), did not assess the stage of chronic renal failure one year after surgery, thus probably demonstrating the high percentage of its achievement (54.1 %). A positive surgical margin was observed in 1 (2.7 %) patients. Warm ischemia time of more than 25 minutes was used in 8 patients (21.6 %). Complications in the postoperative period (Clavien–dindo II and higher) were observed in 1 (2.7 %) patient. Trifecta and quadfecta rates were 78.4 % and 54.1 %, respectively. To analyze the surgeons’ experience, 37 renal cell cancer patients were divided into two subgroups with first 20 and subsequent robotic partial nephrectomies. There were no differences in gender, age and calculated RENAL value between 2 subgroups. depending on the surgeons’ experience, statistically significant differences in the duration of surgery (p=0.035) and blood loss during surgery (p=0.007) were found. Conclusion. Considering the extensive experience of surgeons in the field of laparoscopic surgery for tumors of the renal parenchyma, the outcomes of robotic partial nephrectomies performed in 37 patients seem to be satisfactory and successful. The accumulated experience of surgeons after 20 robotic-assisted nephron-sparing surgeries makes it possible to significantly reduce surgery time and blood loss. The technique of robotic-assisted partial nephrectomy requires further improvements.

ОСТРЫЙ ГНОЙНЫЙ ДВУСТОРОННИЙ ПИЕЛОНЕФРИТ: ДИАГНОСТИКА И ЛЕЧЕНИЕ

Background. Acute purulent bilateral pyelonephritis is the most severe form of acute pyelonephritis. The disease is often accompanied with oligo- or anuria and is complicated by urosepsis. Purpose of the study. To analyze information content of diagnostic methods and immediate results of treatment of patients with acute bilateral pyelonephritis in the phase of purulent inflammation. Material and methods. 44 patients with acute bilateral pyelonephritis were observed. The purulent process in both kidneys was diagnosed by ultrasound and contrast-enhanced computed tomography (CT). Urosepsis was laboratory confirmed in 34 patients. All patients were operated on both sides. Organ-preserving surgeries were performed in 43 cases, and both kidneys were removed in one patient. Histological examination of fragments of the kidney parenchyma confirmed the purulent process in 41 patients. After surgery all patients received targeted antibacterial and detoxification therapy. Results. After operations 5 patients died due to the progression of multiple organ failure. After surgery two patients required hemodialysis due to the development of anuria. 37 patients were discharged from the clinic in a satisfactory condition. 1 year after the operation 19 were diagnosed with chronic renal failure stage III. Conclusions. 1. CT with contrast enhancement is the best method for detecting foci of purulent destruction in the renal parenchyma. 2. Acute purulent bilateral pyelonephritis in 77.3% is complicated by urosepsis which requires intensive complex treatment: surgical debridement of purulent foci in both kidneys followed by long-term targeted antibacterial and detoxication therapy. 3. The prognosis for acute purulent bilateral pyelonephritis is always uncertain for life and poor for recovery.

Hormonal imbalance in patients with chronic kidney disease in the pre-dialysis and dialysis periods (part 2)

In the previous article, we presented the results of literature review showing the changes in hormone concentrations (parathyroid hormone, insulin, growth factor, prolactin) in patients with chronic renal failure (CRF) at the pre-dialysis and dialysis stages, described pathological relationships between renal failure and serum hormones concentrations, as well as changes in their biological effects. In this article, that continues the general topic, we provide the results of literature review that shows changes in serum concentrations of thyroid, adrenal, sex hormones and the features of the functioning of hypothalamus-pituitary-peripheral glands axis in patients with CRF. The presence of close pathogenic interactions of renal functional condition with hormonal activity of the thyroid gland was evaluated, as well as the ability of thyroid gland to influence the CRF progression both during pre-dialysis and dialysis sta­ges of CRF. Most patients with CRF have low serum triiodothyronine and thyroxine levels. It means that CRF is a pathological condition associated with thyroid hypofunction that progressively worsening as glomerular filtration rate decreases. For patients receiving dialysis treatment, hypothyroidism is associated with higher mortality. Secondary adrenal insufficiency is usually progresses in patients on renal replacement therapy. Non-diagnosed chronic adrenal failure may be life-threating that’s why the analysis of adrenal function is especially actual for patients on both pre-­dialysis and dialysis stages of CRF. Secondary adrenal insufficiency caused by long-lasting treatment with corticoids is a diagnostic problem for patients on dialysis treatment, because many nephrological diseases are treated by corticoids, and immunosuppressive therapy protocols used after the kidney transplantation are usually include prednisone. As the endocrine dysfunction progresses in patients with CRF, sexual dysfunction develops due to sex hormone imbalance. Abnormal androgen concentration is a typical fin­ding in CRF. A negative correlation was found between endogenic testosterone concentration and CRF stages I–V that indicated an abnormal profile of male sex hormones. There are gender-specific features of the development and progression of clinical symptoms of hormonal imbalance. The number of experimental studies show that continuous estradiol treatment may prevent the development of glomerulosclerosis. The results of clinical trials concluded that lower CRF progression and the lower incidence of CRF observed in young females compared to males, as well as the absence of gender protection in post-menopausal period, shows the important role of female sex hormones.

Laparoscopic nephrectomy for polycystic kidney disease: Benefit or necessity?

Background. According to foreign and domestic authors, autosomal dominant polycystic kidney disease (ADPKD) is a disease accompanied by a progressive deterioration in the functional state of the kidneys and occupies a significant contribution to the structure of all causes leading to the end stage of chronic renal failure (ESRD). An increase in the volume of the kidneys and the development of complications significantly worsen the quality of life of these patients. Open surgical interventions are accompanied by a more severe course. In this connection, the question of choosing the timing and method of surgical intervention in this group of patients remains relevant.
 Aim. To evaluate the results of nephrectomy in patients with ADPKD for the period from 2016 to 2022, performed at the Krasnoyarsk Regional Clinical Hospital.
 Materials and methods. Within 6 years, 22 nephrectomies were performed in 20 patients with ADPKD. Monolateral nephrectomy was performed in 12 cases, simultaneous bilateral surgery was performed in eight patients. The mean age of the patients was 51.3±7.9 years. Mostly nephrectomy was performed by laparoscopic approach (17 patients), lumbotomy operation was performed in three patients. The need for conversion during laparoscopic operations was not noted.
 Results. Open surgical treatment was performed only because of uncontrolled gross hematuria and suppuration of cysts. All patients were transferred to the intensive care unit after surgery. Repeated surgery due to the development of bleeding was required in 33.3% of cases. The need for an inpatient stage of treatment was 15.1±2.8 days. In one case, a fatal outcome was recorded. Laparoscopic nephrectomy was performed in 17 patients, monolateral in seven patients, staged bilateral in two, and simultaneous bilateral in eight patients. In 41% of cases, in addition to pain and hypertension, nephrectomy was due to the upcoming kidney transplantation. The average volume of removed kidneys was 3138.74±356.30 ml. The average bed-day was 8.86±2.4 days.
 Conclusion. The increase in the number of patients with ADPKD and ESRD raises the question of the improvement in their quality of life that can be achieved by unilateral or bilateral nephrectomy. However, there are no clearly regulated criteria that determine the indications for these types of surgery. Despite certain difficulties, we believe that laparoscopic nephrectomy in patients with ADPKD and ESRD is the most optimal.

An unusual cause of diplopia and blurred vision in a patient with renal insufficiency.

We report the interesting case of a 75-year-old patient who presented with sudden onset of diplopia and a blurred vision of the right eye. Recurrent headaches in the temporal region were reported as further symptoms. Clinical examination revealed abduction restriction on the right side and bilateral vascular congestion in the anterior segment of the eye, and marked chemosis. As relevant pre-existing conditions, the patient had severe hypertension, long-standing nicotine abuse (>50py), 3-vessel coronary artery disease, myocardial infarction 33 years ago, and cardiac bypass surgery five years ago. Furthermore, the patient suffered from chronic renal failure stage G5D, according to Kidney Disease Outcomes Quality Initiative (K/DOQI), with the need for dialysis. For this reason, a polytetrafluoroethylene loop shunt was created on the right cubital region five years ago, which underwent thrombectomies one year ago and three months ago. During the last revision, the shunt was extended to the internal jugular vein to improve patency, which was not reported by the patient with a language barrier, and no documentation from the external hospital was available.

#3739 SHUNT PORTOSYSTEMIC COMPLICATED BY HYPERAMMONEMIA AND HEPATIC ENCEPHALOPATHY SUPPORTED BY DAILY DIALYSIS IN A CHRONIC HEMODIALYSIS PATIENT

Abstract Background and Aims Hepatic encephalopathy is a neuropsychiatric syndrome that may develop as a consequence of liver insufficiency. In acute liver failure, hepatic encephalopathy suggests the severity of the disease. In end-stage chronic liver diseases, episodes of hepatic encephalopathy are frequently fully and spontaneously reversible. Clinical manifestations vary from mild neuropsychiatric disorders to coma. The pathogenesis of hepatic encephalopathy is complex and not clearly understood. Ammonia plays a key role. In the healthy individual, ammonia is, during its first hepatic passage, directly degraded into urea, itself excreted by the kidney and the stools, and to a lesser degree in glutamine. Ammonia is also metabolized by the muscle striped. In case of liver failure and/or shunts portosystemic, there is a defect in hepatic clearance ammonia which is then found in excess in systemic circulation. Decreased muscle mass, linked to malnutrition, frequent in the patient cirrhotic and chronic hemodialysis, also helps to decrease metabolism ammonia. Due to the increase in permeability of the blood-brain barrier, the brain is exposed to excessive concentrations ammonia causing functional brain abnormalities and structural, which can partly explain the signs neurology of hepatic encephalopathy. In end stage chronic renal failure, clearance of ammonia via extracorporeal treatment has not been systematically evaluated. Several studies with small samples have demonstrated the effectiveness of hemodialysis, compared to peritoneal dialysis, in terms of ammonium purification in chronic renal failure, on dialysis or not on dialysis. The aim of this study was to evaluate the effectiveness of daily dialysis for the purification of ammoniumin a chronic hemodialysis patient with hepatic encephalopathy. Case Report A 40-year-old man undergoing chronic hemodialysis was referred to gastroenterology department of Mohammed VI University center of Marrakesh for inoperable shunt portosystemic complicated by hyperammonemia causing hepatic encephalopathy consisting of headaches and seizures. His medical history was significant for liver cirrhosis caused by infection with hepatitis B, end stage kidney disease due to membranoproliferative glomerulonephritis, for which the patient is on hemodialysis at the rate of 3 sessions per week. The patient went on to develop portal hypertension and ascites requiring frequent hospital admissions and treatment with diuretics. He was on a low-protein and low-sodium diet. While on oral furosemide 250 mg daily and spironolactone 100 mg daily, his diuresis was adequate. Before referral, this patient had already suffered 4 episodes of tonic clonic seizures. His 1st hemodialysis session in our training was on January 10, 2023, he was given daily hemodialysis sessions with daily blood tests, including immediate pre and post dialysis ammonia. Pre-dialytic ammonia levels varied between 103 and 161 µmol/l, as well as post-dialytic ammonia levels varied between 24 and 37 µmol/l, knowing that the normal value of laboratory ammonia varied between 10 and 51 µmol/l. The evolution was marked by a clear clinical improvement, with a disappearance of the seizures without a significant drop in ammonia after 14 daily hemodialysis sessions. Serum creatinine and urea declined, and sodium increased. Accumulation of ascites slowed and the patient could eat and sleep normally and was again independent with self care. The patient returned home on January 24. Conclusion This study shows the interest of daily hemodialysis sessions as a potential treatment for hyperammonemia in a patient on chronic intermittent hemodialysis, with a portosystemic shunt. The interest lies in the fact that the improvement is mainly clinical than biological (persistent hyperammonemia).

Experience of conducting the first Russian cardiology hackathon Cardio data hack

This article is about the experience in organizing and conducting the first Russian cardiology hackathon Cardio data hack UFA 2022 which took place in Ufa in November 2022. It describes the preparation stages and organizational conditions of the hackathon conducting, the ways of interacting between the event organizer and participants, and the methods of evaluating the tasks. The first hackathon case was the recognition of ventricular bigeminy in patients with 24-hour ECG recording; the second case was performing a meta-analysis of the studies which assessed efficacy and safety of oral anticoagulants in atrial fibrillation and chronic renal failure stages IV and V. The hackathon attracted 179 registered participants who formed 42 teams, but further only 37 of them confirmed their participation and formed 8 teams. 7 teams gave the final solution of the tasks, and 5 of them presented their results with 3 of them giving solutions for both cases. Eventually, there were obtained the prototypes of solution for bigeminy recognition during Holter monitoring and high-quality meta-analyses evaluating the efficacy and safety of oral anticoagulants.

Evaluation of Adjusted Calcium Levels in Patients of Chronic Renal Failure with Hypo-Albuminemia

Objective: To compare adjusted calcium levels with ionised Calcium in chronic renal failure patients with hypoalbuminemia for the correct assessment of their Calcium status.
 Study Design: Cross-sectional study.
 Place and Duration of Study: Department of Chemical Pathology and Endocrinology, Armed Forces Institute of Pathology, Rawalpindi Pakistan, from Mar 2020 to Jan 2021.
 Methodology: A total of 304 individuals aged 18 to 90 years, of either gender were included in the study. Participants were differentiated into stages of Chronic renal failure based on the estimated glomerular filtration rate calculated through the Chronic Kidney Disease Epidemiology Collaboration equation. Serum total Calcium, urea and creatinine were analysed on ADVIA 1800R Clinical Chemistry Auto analyser. In addition, ionised Calcium was analysed on Cobas b221 blood gas and electrolyte analyser.
 Results: Mean age of the study participants was 56.3±16.03 years. 130(42.5%) individuals had stage-5 while 102(33.3%) had stage 4 chronic kidney disease. Based on ionised Calcium concentration, 37.3% of participants had hypocalcaemia, 57.2% had normocalcaemia, and 4.9% had hypercalcaemia. 57.5% had albumin concentration between 20-29g/L. Cohen’s Kappa statistical analysis showed adjusted Calcium to be a poor predictor of the correct Calcium status of the patients with hypoalbuminemia.
 Conclusion: Adjusted Calcium, using the Modified Payne formula, overestimates Calcium status in patients of chronic renal failure with hypoalbuminemia when compared with total unadjusted Calcium levels hence misclassifying true hypocalcaemic patients as normocalcaemic.Keywords: Adjusted calcium, Chronic renal failure, Estimated glomerular filtration rate, Hypoalbuminemia, Ionised calcium.

Hormonal imbalance in patients with chronic renal failure in the pre-dialysis and dialysis periods (part1)

The review describes the problem of studying progressive changes of hormones concentrations (parathyroid hormone, insulin, somatotropin, prolactin) in patients with chronic renal failure on the pre-dialysis and dialysis stages. The pathogenetic relationships between kidney function deterioration and hormone concentrations as well as changes of their biological effects were evaluated. Parathyroid hormone is considered as an uraemic toxin, since its concentration in the blood begins to increase when the glomerular filtration rate decreases below 50 ml/min. All stages of chronic kidney disease are accompanied by disorders of calcium-phosphorus metabolism. Prolonged excess of parathyroid hormone leads to bone loss and to the progression to secondary hyperparathyroidism that is a frequent complication in patients with the later stages of chronic renal failure and, especially, in those on dialysis treatment. The elevation of insulin level in chronic renal failure is the consequence of progressive decrease in glomerular filtration rate and insulin excretion by proximal tubules. So, it results in insulin half-life prolongation. Long-term dialysis therapy eliminates factors that reduce the degradation of insulin by extrarenal tissues, which results in an improvement of their insulin sensitivity. Experimental and clinical studies have shown that an excess of somatotropin can adversely affect the kidneys that leads to glomerular hyperfiltration and the progression to glomerulosclerosis. The risk of possible side effects on kidneys should be taken into account when prescribing recombinant human insulin-like growth factor. The prolactin concentration is usually increased in chronic kidney disease due to reduced clearance and increased secretion. Hyperprolactinemia manifests as galactorrhea and hypogonadism. Dialysis therapy can’t normalize the increased concentration of prolactin. Modern options for pathogenetic treatment of endocrine disorders in patients with chronic renal failure are outlined in this article. It was found that kidneys play an important role in regulating hormones concentrations in the blood. Endocrine disorders are one of the most important components of the uraemic syndrome, which requires further clinical studies, aimed on the searching of better treatment strategies and prevention of hormonal imbalance on the pre-dialysis and dialysis stages of chronic kidney disease.

A QUASI EXPERIMENTAL STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON KNOWLEDGE REGARDING POST DIALYSIS HOME CARE AMONG CAREGIVERS OF CHRONIC RENAL PATIENTS UNDERGOING HEMODIALYSIS AT SELECTED HOSPITAL OF DISTT. UNA. HIMACHAL PRADESH

Chronic kidney disease (CKD) is the 16th leading cause of years of life lost worldwide. Appropriate screening, diagnosis and management by primary care clinicians are necessary to prevent adverse CKD-associated outcomes, including cardiovascular disease, end stage kidney disease and death. Chronic kidney disease has become a major cause of global morbidity and mortality in developing countries. The burden of Chronic kidney disease in India cannot be assessed accurately. The approximate prevalence of Chronic Kidney disease is 800 per million population and incidence of end stage renal disease is 150-200 per million population. Chronic Kidney Disease is a progressive, irreversible deterioration in renal function in which the bodys ability to maintain metabolic and fluid and electrolyte balance fails resulting in retention of urea and nitrogenous waste in the blood. There are mainly 5 stages of renal failure. The end stage of chronic renal failure must require the long term treatment including dialysis or kidney transplantation. Dialysis makes it possible to continue living with end-stage kidney disease for many years or even decades. Dialysis is a process of purification of blood used to remove fluid and uremic waste products from the body when kidneys cannot do so. Approximately 1.5 litres of blood are filtered by a healthy persons kidneys each day. People whose kidneys either do not work properly cant remove waste products from body. A dialysis machine removes a small amount of a patients blood through a man-made membrane called dialyzer, or artificial kidney to clean out toxins that the kidneys can no longer remove. The filtered blood is then returned to the body. A quasi experimental study to assess the effectiveness of structural teaching programme on knowledge regarding post-dialysis home care among caregivers of chronic renal patients undergoing hemodialysis at selected hospital of distt. Una. The research design selected for the study was pre-experimental research design. Data was collected from 50 samples using convenient sampling technique. Tool was used to collect the data from samples. It consists of 2 sections. Section-A consists of patients and caregivers demographic variables and Section-B consists of structured questionnaire and was analysed by applying descriptive and inferential statistics. A finding reveals that the out of 50 samples 36% of samples were in the age group of 45-60 years, 54% were male, 36% had got education up-to 12th,56% were unemployed, 62% had income less than 10,000 per month, 96% had rural area as place of residence, 56% had nuclear family, 74% had no family history, 68% were married, 80% had belong to Hindu religion, 66% had health care professionals as source of information regarding post dialysis home care. In pre-test mean knowledge score was 11.18+ 3.706 which was 37.27% of total mean knowledge score percentage. In post-test mean knowledge score 17.98+ 3.727 which was 59.94% of total mean score. The difference in pre-test and post-test mean score was 22.67. Hence it concluded that the structured teaching programme was effective. Pairedt test was calculated to analyse the difference between the pre-test and post-test knowledge scores, shows highly significant difference between pre-test and post-test. Hence the stated null hypothesis was rejected. There was only two significant association found between the knowledge regarding post dialysis home care among caregivers of chronic renal failure patients undergoing haemodialysis i.e. Gender and occupation. There was no other significant association between post-test knowledge scores with selected demographic variables such as age, education, income, place of residence, type of family, family history, marital status, religion, source of information. Thus null hypothesis was accepted.

A STUDY OF THYROID PROFILE AND FASTING LIPID PROFILE IN CHRONIC KIDNEY DISEASE

Background: Chronic kidney disease [CKD] is associated with specific abnormalities in the thyroid and lipoprotein metabolism both in the early and in the advanced stages of chronic renal failure. Regardless of age, heart disease is a major cause of morbidity and mortality among patients with renal failure.Our study aimed at to estimate thyroid profile and dyslipidemia in CKD patients on conservative management,on haemodialysisand to compare with healthy controls. Methods: This was a prospective study conducted among the 100 CKD patients and controls over 18 months admitted in the department of general medicine at our hospital. Results: Hundred CKD cases with 70 male and 30 female in a M: F ratio of 2.3:1 were found to be in different stages CKD (12, 29 and 59 in stage-3 to stage-5 respectively). In 59 cases of stage-5 CKD, 32 were on HD and 27 on conservative management. In each grade of CKD, the mean age, eGFR, urea, creatinine, thyroid profile, and lipid profile were computed individually. The levels of urea, creatinine, and eGFR differed significantly across CKD grades 3-5.The thyroid profile differed significantly across CKD grades 3-5. The lipid profile differed significantly across CKD grades 3-5, with p=0.000, >0.05, 0.000, >0.05, >0.05 for total cholesterol, triglycerides, high-density lipoprotein (HDL), low-density lipoprotein (LDL), and very low-density lipoprotein (VLDL) levels, respectively. Conclusions: The number of patients increases with decreasing T3 and T4 and increasing TSH proportionate to the severity of the renal failure, hypothyroidism is becoming more common in people with chronic renal disease.All lipid abnormalities found in CKD on HD have reduced HDL levels in serum along with significant rise in serum triglyceride, serum cholesterol serum LDL level and serum VLDL level.Dyslipidemia in CKD worsened as patientsprogresssed to severe stages with significant increase in TG, TC, VLDLc and TC/HDLc confirming presence of atherogenic lipid profile needing early intervention to prevent cardiovascular complications.

Options for approaches to nephrectomy in patients with end-stage chronic kidney disease caused by autosomal dominant polycystic kidney disease: A review

Autosomal-dominant polycystic kidney disease is a common kidney disease that affects all racial groups around the world, occupies one of the leading places in the structure of urological diseases and forms a significant contribution to the structure of all causes leading to the end stage of chronic renal failure, disabling patients in this group and hence leading to the inevitability of renal replacement therapy. A highly effective clinical method for replacing lost kidney function is kidney transplantation. Based on the fact that the number of patients with this pathology is increasing, it is necessary to search for and introduce clear criteria for the best care, taking into account the high likelihood of developing infectious complications, hematuria, the absence or presence of diuresis, arterial hypertension in this category of patients. The article reflects the various methods of nephrectomy in patients suffering from autosomal dominant polycystic kidney disease, as well as how approaches to nephrectomy have evolved. The results of complications, as well as patient and graft survival in domestic and foreign studies, in which bilateral or ipsilateral nephrectomy was used using open or laparoscopic access before, during or after kidney transplantation, are demonstrated. Preference is rightfully given to minimally invasive methods of surgical treatment. Taking into account the already reduced resources of the organism of these patients, the volume and method of surgical treatment should be carefully chosen, taking into account safety, efficacy and risk minimization.

A comparative qualitative assessment of the severity of diabetic retinopathy in patients with stages III, IV and V, requiring hemodialysis, of chronic renal insufficiency

Purpose. Comparative qualitative assessment of the severity of proliferative diabetic vitreoretinopathy (PDR) in patients with stages III, IV and V of chronic renal failure (CRF). Material and methods. 150 patients (64 % women; 36 % men, aged 38 to 79, mean age 61.3 ± 2.3 years) were examined. The patients were divided into three groups, each consisting of 50 subjects (100 eyes), according to the stages of CRF diagnosed in terms of glomerular filtration rate — CRF-3; CRF-4; and CRF-5, the latter requiring hemodialysis (НD). All groups were approximately equally distributed as to age and gender. A total of 11 qualitative indicators were assessed, including the condition of the fundus, the severity of diabetic macular edema, the degree of fibrovascular tissue neovascularization, the spread of traction retinal detachment to the periphery. All examinations were performed by one ophthalmic surgeon (A.S. Golovin) in order to increase the reliability of the qualitative assessment. The following scoring system was used: 1 point— no changes; 2 points — insignificant (weak) changes; 3 points — moderate severity of changes; 4 points — pronounced changes. Results. For all qualitative indicators, the severity of PDR in patients with HD was significantly higher than in patients with CRF-3 or CRF-4. The average severity of clinical manifestations of PDR for all criteria was 2.10 ± 0.27; 2.35 ± 0.30 and 3.21 ± 0.10 points (p < 0.05) for CRF-3; CRF-4 and CRF-5 (HD), respectively. Conclusion. The severity of retinal violations in patients with HD is 36.5–52.9 % higher compared with patients with CRF-4 and CRF-3. Considering the more severe nature of PDR and somatic status of HD patients, it seems expedient to develop an advanced vitrectomy technology for HD patients, its medical maintenance and anesthetic means.

OPEN SURGICAL TREATMENT OF BILATERAL CORALLOID AND MULTIPLE NEPHROLITHIASIS COMPLICATED WITH CHRONIC RENAL FAILURE

This articles describes the improved preoperative techniques for preparing to the surgical operations for bilateral coralloid and multiple nephrolithiasis complicated with chronic renal failure and discusses the treatment outcomes. Materials and methods. During 2000-2020, at the Department of Urology of the Azerbaijan Medical University, more than 3,000 open surgical operations were performed on for kidney and ureter stones. 974 (32.47±0.85%) paitents had the operations for coralloid and multiple nephrolithiasis; 700 (23.33±0.77%) of them were found to have unilateral and 274 (9.13±0.53%) had bilateral coral stones. Results. The results of open surgical operations of 274 patients operated on for bilateral coralloid and multiple nephrolithiasis in the 2000-2020 period were analyzed. 190 (69.3±2.8%) of them, 105 men and 85 women, had renal insufficiency, 162 (59.1±3.0%) patients (82 men, 80 women) had the diagnosis of chronic renal failure, and 28 (10.2±1.8%) patients (19 men, 9 women) had acute chronic renal failure. The implementation of the preoperative preparation techniques, taking into account the stage of chronic renal failure, was presented. Out of 274 operated patients, the intervention was performed in 47 (17.2±2.3%) with nephrostomy (24 right, 23 left), in 28 (10.2±1.8%) with pyelostomy (16 right, 12 left), in 110 (40.1±3.0%) with intrarenal stenting (60 right, 50 left), in 6 (2.2±0.9%) with nephrostomy and intrarenal stenting (2 on the right, 4 on the left). Along with this, 56 (20.4±2.4%) patients had clamping of the renal artery from one side or another. After surgery, 48 (17.5±2.3%) patients experienced the exacerbation of chronic pyelonephritis. In patients with diabetes, the exacerbation of chronic pyelonephritis had a more severe course. 26 (9.5±1.8%) patients experienced the exacerbation of chronic renal failure, of them, 6 (2.2±0.9%) had a creatinine level exceeding 500 mmol/l, that was the reason for haemodialysis. Anaemia was observed in 49 (17.9±2.3%) patients with chronic pyelonephritis and chronic renal failure in the postoperative period. In patients with anaemia, the haemoglobin level was 50-85 g/l (average 71.9 ± 0.4 g/l). 11 (4.0±1.2%) of them received blood transfusions in the postoperative period. In 5 (1.8±0.8%) cases, transfusion was performed during haemodialysis. In general, 270 patients out of 274 with bilateral coralloid and multiple nephrolithiasis had open surgical treatment completed successfully, and 4 (1.5±0.7%) had fatal outcomes. In 254 (92.7±1.6%) cases, an organ-preserving operation was performed on, and in 20 (7.3±1.6%) cases, surgical resections were carried out. The study has shown the preoperative preparation and the choice of the correct surgical tactics during the operation considerably contributes to successful treatment outcomes among the patients with severe chronic renal failure.

Relationship of proliferative diabetic retinopathy and severe stages of chronic renal failure

Diabetic nephropathy, as a frequent complication in patients with diabetes mellitus (DM), is increasing due to the rapid increase in the prevalence of diabetes, which is considered one of the leading causes of chronic renal failure (CRF). Diabetic retinopathy (DR) and diabetic nephropathy are the two main microvascular complications of DM. Studies show that the prevalence and severity of visual pathology is significantly higher among patients with severe stages of CRF, which is associated with the following risk factors: hypertension, metabolic disorders, uremia, anemia, and the use of anticoagulant therapy. The leading forms of eye pathology in patients with DR and CRF are proliferative DR, macular edema, and vitreous hemorrhage. The main structural changes in the choroid and retina in patients with CRF are the thickness of the choroid, accompanied by a decrease in the density of vessels and the volume of perfusion in the surface capillary layer of the choriocapillaries, which is aggravated with the aggravation of the stage of the disease and is interconnected with impaired renal function. Literature data indicate a positive effect of the hemodialysis procedure on DR. It should be borne in mind that in patients with end-stage chronic renal failure, a hemodialysis session may be accompanied by pain in the eye associated with an increase in blood pressure. Interdisciplinary collaboration between nephrologists and ophthalmologists will ensure improved and adequate treatment of patients with CRF and proliferative DR.

In-center Nocturnal Hemodialysis Reduced the Circulating FGF23, Left Ventricular Hypertrophy, and All-Cause Mortality: A Retrospective Cohort Study.

Fibroblast growth factor 23(FGF23) is the most important biomarker and pathogenic factor in Chronic Kidney Disease–Mineral and Bone Disorder (CKD–MBD). In the moderate and severe stages of chronic renal failure, abnormally elevated circulating FGF23 can lead to some complications, including myocardial hypertrophy, which is positively correlated with all-cause mortality. However, the circulating FGF23 level of different hemodialysis modalities, the underlying essential regulatory factors, and potential clinical benefits remain to be elucidated. In this retrospective cohort study, 90 in-center nocturnal hemodialysis (INHD) and 90 matched conventional hemodialysis (CHD) patients were enrolled. The complete blood count, intact FGF23(iFGF23), calcium, phosphorus, PTH, and other biochemical and echocardiographic parameters of INHD and CHD patients were collected and analyzed at 1-year follow-up. The all-cause mortality was recorded during the 7-year follow-up. Furthermore, the regulatory factors of iFGF23 and its association with echocardiographic parameters and mortality were investigated by multivariate regression. The levels of iFGF23 and serum phosphate in patients undergoing INHD were significantly lower than those in patients undergoing CHD. The left ventricular volume index (LVMI) in patients with INHD was significantly attenuated and positively correlated with the drop of serum iFGF23. The INHD group had reduced all-cause mortality compared to the CHD group. Multivariate analysis showed that iFGF23 was positively correlated with serum calcium, serum phosphorus, and calcium-phosphate product. The calcium-phosphate product is an independent determining factor of serum iFGF23. Compared with the CHD group, the INHD group presented with a significantly reduced circulating iFGF23 level, which was closely associated with attenuation of left ventricular hypertrophy, but INHD reduced all-cause mortality in an FGF23 independent manner.

INVESTIGATING THE EFFECT OF CURCUMIN SUPPLEMENT CONSUMPTION ON SYSTEMATIC INFLAMMATION IN HEMODIALYSIS PATIENTS

Patients with Chronic Renal Failure (CRF) are exposed to extremely high risk for cardiovascular disease compared with others, so that at the initial stages of CRF, the incidence of cardiovascular diseases is higher than the progress of the disease toward the last stage of failure. Therefore, the present study aimed to investigate the effect of curcumin on serum lipid profile and systematic inflammation in hemodialysis patients. In this study, clinical practice was performed on 64 hemodialysis patients in Mashhad’s hospitals. Sampling in this study was based on random assignment method in the form of permuted block randomization. After gathering information, they were coded and transferred to the computer and after ensuring the accuracy of data, they were analyzed by SPSS 16 and chi-square test, fisher test, t-test, and Kolmogorov-Smirnov test. According to the analyses, the results of hypotheses testing showed that curcumin supplement consumption does not decrease the concentration of triglyceride, cholesterol, LDL of hemodialysis patients, and CRP. Also, the results of this study showed that curcumin supplement only has a slight effect on decreased cholesterol concentration, LDL of serum, and CRP in hemodialysis patients.

MO568: The Relationship Between Oxidative Stress and Undernutrition in CKD  Patients

Abstract BACKGROUND AND AIMS Undernutrition is frequent in patients with chronic renal failure. It affects 35% of patients at the start of dialysis and represents one of the causes of morbidity and mortality. The objective of this work is to determine the relationship between oxidative stress and undernutrition in patients at different stages of chronic renal failure. METHOD A descriptive longitudinal study of 162 patients with chronic renal failure at different stages (2, 3, 4, 5 and 5D). We have studied the biological and anthropometric nutritional parameters in CKD patients at different stages as well as markers of oxidative stress, and we have studied their correlations with undernutrition in these patients. RESULTS The mean age of the patients is 56.5 ± 17 years with a sex ratio of 1.43. Regarding markers of oxidative stress, MDA, MPO and AOPP were studied. The means of which are respectively (6.1 ± 0.12 μmol/L, 59 0.89 ± 1.98 IU and 61.89 ± 1.4 μmol/L). The average body mass index, albumin and pre-albumin levels are respectively: (21.98 ± 0.28), (37.84 g/L ± 0.47) and (302.93 mg/L ± 5.4). All three parameters decrease significantly (P <0.05) with degradation of renal function (from stage 2 to stage 5D) and increase in markers of oxidative stress with a negative correlation (P < 0.05). The most undernourished patients are found in stage 5 and 5D with high levels of oxidative stress markers. Undernutrition is greater in patients with severe CKD and in hemodialysis patients with high levels of oxidative stress markers. CONCLUSION Chronic renal failure represents a real public health problem. Undernutrition is one of the causes of morbidity and mortality in these patients, especially after extra renal treatment, hemodialysis, oxidative stress worsens undernutrition and cardiovascular morbidity.

Nutritional status of patients according to the stage of chronic renal failure

Introduction. In Burkina Faso, chronic kidney disease (CKD) is a major public health problem due to its increasing prevalence, severity and the high cost of treatment. Aim. The aim of this study was to describe nutritional status of subjects diagnosed with severe and moderate stages of chronic renal insufficiency, followed in nephrology consultation at the Yalgado Ouedraogo University Hospital Center (YO-UHC) of Ouagadougou. Methods. A descriptive cross-sectional study conducted over a period of eight months and included 75 patients in total. The social-demographic parameters were determined on the basis of the patients' declaration and the use of their medical records. Biological parameters were collected from the results of laboratory examinations performed by each patient. The nutritional status of the patients was assessed by the anthropometric method. Finally, all patients were asked about their dietary habits and lifestyle using the 24-hour recall method. Results. Our results revealed a male predominance, out of the total number of patients included. The percentage of men and women was 54.70% and 45.30% respectively with a sex (male/female) ratio of 1.20. The average of Body Mass Index was 24.79 Kg/m2. The percentage of overweight and obesity of women was 64.71% compared to 26.83% for men. The proportion of women with severe chronic kidney disease (58.82%) was twice as high as that of men (29.27%), (P<0.05). The average waist circumference of the subjects aged 30-39 years was significantly lower than that of the subjects aged 60-85 years. So, average hip circumference was 93.77 cm, with a significant difference according to sex (P<0.05). The prevalence of hyperglycaemia and diabetes increased with age. Hyperglycaemia in the 40-49 age group was increased significantly from 16.67% to 26.67% in the 70-85 age group (P<0.05). Diabetes in the 50-59 age group was 10% and doubled in the 70-85 age group (P<0.05). A percentage of 67.99% of the patients had a history of hypertension in either first-degree relatives or collaterals. The highest proportion was found in the hypertensive collaterals (37.33%; P=0.059). This study revealed a low level of physical activity among all patients. Only 38.67% of the patients practiced regular physical activity. There was no significant association between the level of physical activity and the stage of renal failure. Conclusion. Knowledge of nutritional status is a crucial part of better nutritional management of CKD patients. Finally, previous studies on the dietary habits of patients suffering from CKD will allow a better understanding of their nutritional status for a better management according to the stage of progression of the disease.

POS-260 Polycystic kidney disease in Chad: about 26 cases

Polycystic kidney disease is the most common inherited kidney disease with easy diagnosis by ultrasound. The aim of our work was to study the epidemiological, clinical, paraclinical and therapeutic aspects of renal polyskystosis in Chad and to assess the value of screening in patients at risk. We carried out a descriptive cross-sectional study over a period of 26 months (January 1, 2018 to May 1, 2020) in the two nephrology departments of the Renaissance and the National Reference centers of N’Djamena. were included all patients who had polycystosis (PEI ultrasound criteria). Then a family survey was carried out among family members of patients included between June 1, 2020 and October 1, 2020 During our study, 2229 patients had consulted in the 2 university hospitals. Fifteen (15) cases met the ultrasound criteria for PEI, as a hospital prevalence of 0.67% of cases. From these 15 cases, a family investigation was carried out on the members of 3 families. Eleven (11) patients were diagnosed as carriers of polycystic kidney disease (Figure 2). We identified a total of 26 cases in our study, as a prevalence of 1.16%. The average age was 42.4 years [15 and 70 years] with a sex ratio of 1.3. The mean age of onset of the first clinical signs was 37.7 years. Arterial hypertension (hypertension) was the main circumstance of discovery in 53.8% (n = 14) followed by abdominal pain, urinary tract infection and chronic renal failure in respectively 7.6% (n = 2); 7.6% (n = 2) and 3.8% (n = 1). Grade I, II and III hypertensions were found in 42.1%, respectively (n = 8); 36.9% (n = 7) and 21% (n = 4). There was a statistically significant relationship between circumstance of discovery and age (p = 0.034). A hemoglobin level of between 8 and 10g / dl was found in 57.7% of cases. The mean serum creatinine level was 45 mg / l with [4.5 to 274.42 mg / l]. It was noted that 12 patients or 46.1% of patients were in the chronic renal failure stage, including 26.9% in the end stage. All had received conservative treatment. In multivariate analysis, there was a statistically significant relationship between the different stages of chronic kidney disease and the occurrence of complications (p = 0.0000). Therapeutically, 14 patients (53.8%) were on antihypertensive drugs such as ACE inhibitors. No patient had received Tolvaptan. Urinary tract infections were the main complications (19.2%) of hypertension in the blood (15.3%) and macroscopic hematuria (15.3%). Polycystosis in Chad is an unrecognized and underdiagnosed pathology. Clinical screening should focus on the etiological research of arterial hypertension in the young subject and ultrasound screening of family members of the polycystic patient.