Stage VD Research Articles

Left Ventricular Global Longitudinal Strain and H2FPEF Score in Chronic Kidney Disease Patients with Preserved Left Ventricular Ejection Fraction

Abstract Background Cardiovascular disease is the leading cause of mortality in patients with chronic kidney disease (CKD). Although they have mostly normal left ventricular systolic functions using conventional echocardiography some of them develop symptoms of heart failure with preserved ejection fraction (HFpEF) (Dubin et al, 2017), (Edwards et al, 2008). Objective This study aims to assess left ventricular global longitudinal strain and H2FPEF score in chronic kidney disease patients with preserved left ventricular ejection fraction. Patients and Methods The current study was a prospective study that included a total of 100 patients who were referred to our center (Ain Shams University Hospitals) nephrology clinic. Data was collected on patient arrival to our hospital and then echocardiography including LVGLS was done to all patients. All clinical and echocardiographic data were utilized do assess HfPEF probability using H2FPEF score. Results The mean age of our patients was 43.2±15.7 years and 58% of the patients were men. Ninety- five % of patients were hypertensives with more than 94 % receiving two or more anti-hypertensive medications while atrial fibrillation was found in 30% of the patients. Dialysis patients (stage Vd CKD) represented 52% of patients while stage III CKD represented 43% of patients. The patients’ hemoglobin ranged from 9-13.5 gm/dl with mean 10.415 ± 1.259. According to H2FPEF score, 29 (29%) patients had high probability to have HFpEF. Left ventricular Global longitudinal strain (GLS) in 54 patients was less negative than -16 (65.85%). Global longitudinal strain GLS showed positive correlation with H2FPEF score r = 0.406, P-value <0.001. Figure 1 Conclusion Chronic kidney disease is strongly associated with reduced global longitudinal strain and with high probability of HFPEF.

Physical functional capacity assessment in children with chronic kidney disease: A cross sectional observational study.

Chronic kidney disease (CKD) leads to reduced muscle mass and strength in children resulting in a decrease in functional capacity. The objectives of this cross-sectional observational study were to evaluate and compare the functional capacity and muscle strength in children with CKD stage I - V (group A), on dialysis (stage VD) (group B), and kidney transplant recipients (KTR) (group C) in Indian children. 60 children, 20 each in groups A, B, and C were enrolled. Children who could not do the tests and transplant recipients within 6 months of transplantation were excluded. Functional capacity and muscle strength were assessed by 6-minute walk distance (SMWD), timed floor-to-stand test (TFTS), and hand grip strength (HGS). The mean age of the group was 12.54 ± 2.96 years. Among groups A, B, and C, the SMWD in meters (465.90 ± 68.85, 381.45 ± 50.88, 509.05 ± 43.37), TFTS in seconds (9.93 ± 1.77, 10.36 ± 1.30, and 7.68 ± 0.76), and HGS in kg were (12.7 ± 3.85, 10.4 ± 3.02, 19.75 ± 4.45), respectively (p &lt; 0.001). Group C had the best physical functional capacity. The SMWD and HGS had a moderate positive correlation (r = 0.658, 0.658, respectively), and TFTS had a negative correlation (r = -0.605) with estimated glomerular filtration rate (eGFR). The mean HGS and TFTS were different between groups A, C, and B, C (p < 0.05) and not between A and B. The SMWT was however different between A, B, and C (p < 0.001). Muscle strength and functional capacity were most impaired in Indian children on hemodialysis and best preserved in KTR.

Study of the Urinary TGF-β1 Profile in Diabetic Nephropathy: A Single-Center Experience From India.

Background Diabetic nephropathy is one of the important causes of end-stage kidney disease (ESKD). Of the various cytokines playing a role in the pathogenesis of diabetic nephropathy, transforming growth factor beta-1 (TGF-β1) is an important one. Its major role is to mediate extracellular matrix deposition. Increased renal expression of TGF-β1 is found in diabetic nephropathy and its urinary excretion can serve as a useful marker of outcomes. Material and methods A prospective observational study was conducted, which included 10 cases of diabetic nephropathy in group A with age ≥ 18 years and a urinary protein creatinine ratio (UPCR) value of > 0.5 mg/mg and 10 healthy controls in group B. Patients with active urinary tract infection, chronic kidney disease (CKD) stage Vd patients on maintenance hemodialysis, and renal transplant recipients were excluded from the study. Urinary TGF-β1 level estimation in a 24-hour urine sample, 24-hour urine protein, and other baseline laboratory investigations were done. Results In diabetic nephropathy cases (group A), the mean value of urinary TGF-β1 levels was 88.33± 12.44 ng/24 hours. In the control group (group B), the mean value of urinary TGF-β1 was 29.03 ± 3.23 ng/24 hours. Urinary TGF-β1 levels were significantly elevated in group A as compared to group B (p<0.001). There was no significant correlation between urinary TGF-β1 levels andestimated glomerular filtration rate (eGFR) (r=0.376, p= 0.285) as well as the urinary TGF-β1 levels and 24-hour urine protein levels (p = 0.334, r = 0.341) in diabetic nephropathy cases. Glycosylated hemoglobin (HbA1c) levels didn't correlate with the urinary TGF-β1 levels (r = -0.265, p = 0.46). Conclusion The urinary TGF-β1 levels were significantly elevated in diabetic nephropathy patients as compared to healthy controls. There was no significant correlation between urinary TGF-β1 levels and proteinuria,eGFR, or HbA1c levels in diabetic nephropathy patients.

PREDICTORS OF FRACTURES IN PATIENTS WITH STAGE VD CHRONIC KIDNEY DISEASE TREATED WITH HEMODIALYSIS

Bone pathology begins in the early stages of chronic kidney disease (CKD), but clinical consequences — bone pain and fractures — occur mainly at stage 5 of the disease (VD) in patients who use methods renal replacement therapy. Objective. To find out the frequency, localization and possible predictors of fractures in patients with CKD VD stage on the background of hemodialysis according to the results of a prospective study. Methods. 254 patientswere included in the cohort prospective open study with CKD VD stage, which was treated with hemodialysis hemodialysis during 2018‒2022. The study was conducted in two stages. On the first, based on the analysis of medical documentation, received data on the presence of fractures of all localizations, diabetes, hypertension, secondary hyperparathyroidism, hyperhydration, type of initial vascular access, eKt/V, body mass index (IMT), peripheral vasculardisease. At the second stage, a prospective study of new cases of fractures was conducted. Results. Examined72 (32.3 %) women and 151 (67.7 %) men, average age — (49.4 ± 14.03) years — did not differ significantly depending on gender (p = 0.1088). The most frequent cause of CKD stage VD was glomerulonephritis — 111 patients (49.77 %). At the time of the beginning of observation, 30 cases were ascertained fractures in 26 patients, and at the end — 62 in 51 patients. By the results of univariate Cox regression analysis it was established that independent predictors of occurrence new fractures are the patientʼs age, female gender, smoking, presence of peripheral vascular diseases, BMI, as well as serum albumin, parathyroid hormone, calcium, phosphorus, alkaline phosphatase, and vitamin D levels. Conclusions. The developed method of fracture risk assessment for patients with CKD VD stage on the background of hemodialysis is individualized, accessible in execution and interpretation, allows to distinguish patients with increased risk the occurrence of fractures with the help of standard bases clinical and laboratory indicators.

Some indicators of hemostasis and mortality from thrombotic complications in patients with CKD stage VD who were treated by programmed hemodialysis (five-year follow-up)

Annotation. Thrombotic complications in patients with stage VD chronic kidney disease (CKD), treated by program hemodialysis is one of the causes of high mortality in this category of patients; its major pathogenetic component proved to be hemostatic system disturbances characterized by systemic activation of blood clotting process leading to the development of thrombophilia. Objective – to study the biochemical molecular markers of hemostasis in patients with stage VD CKD, treated by program hemodialysis, and to determine their long-term effect on the development of thrombotic complications and mortality. The study included 88 patients (52 males and 36 females) aged 26 to 65 years with stage VD CKD, treated by program hemodialysis. The patients were followed up for five years. Soluble fibrin (sF) level was determined by two-site enzyme-linked immune-sorbent quantitative assay; D-dimer – by enzyme immunoassay using specific monoclonal antibodies to D-dimer epitopes; protein C (pC) activity in blood plasma was estimated by its activation with copperhead snake venom followed by spectrophotometry with wavelength 405 nm. Blood plasma fibrinogen was determined using thrombin-like enzyme Antsistron-H by spectrophotometry with wavelength 280 nm. Blood plasma fibrinolytic activity was evaluated by the relationship between D-dimer and soluble fibrin. Processing of materials was carried out using the methods of variation statistics and correlation analysis. During five years of follow up there were 13 deaths (14.8%), 7 among males and 6 among females, caused by thrombotic complications. The main thrombotic complications were myocardial infarction (6), ischemic stroke (4), mesenteric thrombosis (2) and disseminated intravascular coagulation syndrome (DIC) (1) (according to pathomorphological data). The patients of general group were found to have significantly increased sF level, decreased pC as compared to the control group, as well as twofold increase of fibrinogen concentration along with decreased D-dimer/sF ratio and no response of D-dimer to increased soluble fibrin level. The tendency of D-dimer/sF ratio to increase in those who died because of thrombotic complications could be indicative of microthrombosis with formation of fibrin derivatives along with mild activation of fibrinolysis. Correlation relationships between soluble fibrin and D-dimer, fibrinogen and protein C in general group were assessed, and the following data were obtained: medium direct relationship between soluble fibrin and D-dimer (r= 0.56) (p&lt;0.001), and absence of correlation with fibrinogen (r= -0.12) and protein C (r= -0.10) (p˃0.1). Besides, strong positive correlation was demonstrated between D-dimer and soluble fibrin (r= 0.87) (p&lt;0.001), and moderately negative one between D-dimer and protein C (r= -0.21) (p&lt;0.05). It should be noted that in patients with thrombotic complications, positive correlations between soluble fibrin and D-dimer become stronger (r= 0.51) (p&lt;0.001), as well as negative ones between soluble fibrin and protein C (r= -0.22) (p&lt;0.05). Depressive state of anticoagulant component along with activation of coagulation factors are supposed to be one of the indicators predicting thrombophilia in this category of patients.

Predictors of cardiovascular disease in patients with chronic kidney disease VD stage treated with hemodialysis

The aim of the study was to establish the frequency and possible predictors of cardiovascular disease (CVD) in chronic kidney disease (CKD) VD stage patients, treated with hemodialysis, based on results of prospective observation. The prospective observational cohort study included 223 patients with CKD V D stage who were treated with hemodialysis (HD) during 2012-2019. The research was carried out in two stages. At the first stage, main demographic, laboratory and clinical characteristics of patients, including the frequency of CVD, at the time of beginning the study were examined. At the second stage, based on prospective studying of the dynamics of the frequency of CV pathology, an assessment of potential predictors of CVD in CKD V D stage patients treated with HD was made. Patients’ characteristics determined at the beginning of the study were used as possible predictors. The average duration of prospective study was 35.5±17.8 months, cumulative – 579.3 patient-years. For determination of prognostic factors of CVD events, ROC-analysis, univariate and multivariate Cox proportional hazard regression analysis were done. The primary endpoint (newly diagnosed CVDs) was assesses at the end of the study. Statistical processing of the obtained results was performed using the MedCalc Statistical Software, version 19.3. During the study period, a significant increase of all CVD frequency by 80% (р&lt;0.001) was stated, more than twice – of coronary artery disease (CAD; р&lt;0.001) and atrial fibrillation (AF; р=0.0039). The incidence rate of CVD and CAD was 9.8 and 9.15 per 100-patient-years, respectively. The primary endpoint was observed in 92 (41.26%) patients: newly diagnosed CAD – in 53 patients, heart failure – in 12 patients, AF – in 9 patients, acute myocardial infarction – in 8 patients, other heart diseases – in 10 patients. Independent predictors on increased CVD risk in chronic kidney disease VD stage patients treated with hemodialysis are: age over 35 years, use of a central venous catheter as a vascular access during HD initiation, history of nasal MRSA collonization. In the other hand, serum albumin level of more than 36,6 g/l was associated with reduced risk.

RELATIONSHIP BETWEEN PRE- AND POST-THROMBOSIS FACTORS IN PATIENTS WITH STAGE VD CKD TREATED BY LONG-TERM HEMODIALYSIS

The aim: To determine informative value of pre-thrombosis, post-thrombosis and anticoagulation factors as well as their correlations for assessment of hemostasis status in patients with stage VD CKD. Materials and methods: Potential predictors of thrombophilia development as well as their relationships depending on the level of molecular markers of hemostasis were studied in 88 patients with stage VD CKD undergoing long-term hemodialysis with the view to determine their informative value. Results: Accumulation of soluble fibrin (sF) was demonstrated to cause moderate reaction of D-dimer (D-d) being insufficient in the absence of reaction of anticoagulant component of hemostasis. Soluble fibrin levels were found to be associated with D-d concentration (r = 0.39) and functionally inactive prothrombin forms (FIPF) to some extent (r = -0.24). Accumulation of FIPF in individuals with high level of sF implies significant activation of blood coagulation system at the stage prior to thrombin formation. Absence of close relationship between pre- and post-thrombosis indices may be indicative of still preserved potential of anticoagulant component of hemostasis. Conclusions: Accumulation of FIPF is an early marker of activation of blood coagulation and possible thrombosis. Levels of sF correlate with pre-thrombosis (fibrinogen, FIPF) and post-thrombosis (D-d) factors being associated with inhibition of anticoagulation processes. Comprehensive study of basic components of hemostasis in patients with VD stage of chronic kidney disease offer broader opportunities in arranging prophylactic measures to prevent thrombophilia.

New method in assessment of blood plasma coagulation balance

Introduction: Thrombotic complications associated with disorders of hemostatic system are quite common among various categories of patients and require timely objective assessment of coagulation balance. Aim: To develop an integrated index of assessment of blood plasma coagulation balance using the method of ‘overall haemostasis potential,’ and to test its practical value in clinical settings. Material and methods: 179 patients were studied: 88 with chronic kidney disease (CKD) of VD stage, treated by program hemodialysis, and 91 with ischemic heart disease (IHD) after percutaneous transluminal coronary angioplasty (PTСA). The state of overall coagulation and fibrinolytic potentials was studied in all patients using the method of overall hemostasis potential (OHP). Based on this method, coagulation index (CI) was calculated and tested in such categories of patients. Results and discussion: Patients with stage VD CKD demonstrated the tendency to hypocoagulation, while those with coronary heart disease (CHD) and PTСA – significant hypercoagulation, being indicated by CI index. Conclusions: Patients with stage VD CKD have the tendency to hypocoagulation, while those with CHD and PTСA – to hypercoagulation. The integrated index suggested for assessment of coagulation potential – coagulation index – can adequately reflect coagulation balance disorders and considerably simplify their quantitative assessment.

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.

Features of hemostasis disorders in patients with CKD VD stage and their relationship with the course of the disease

Disorders in the hemostatic system leading to the development of thrombosis are one of the main complications in patients with chronic kidney disease (CKD) of stage VD who are on program hemodialysis. The development of thrombophilic syndrome as a process of intravascular coagulation is characterized by systemic activation of procoagulative mechanisms, which are not always compensated by internal natural anticoagulant systems. The determination of early predictors of possible thrombogenesis in the studied category of patients causes significant difficulties. The goal is to study the features of hemostatic system disorders in patients with CKD VD stage who are on programmed hemodialysis, and to assess their relationship with the characteristics of the course of the disease. In 88 patients with CKD of the VD stage who are on program hemodialysis (52 men and 36 women), the features of hemostasis disorders depending on the clinical characteristics of the patients were studied. The indicators of prethrombosis (soluble fibrin (sF), fibrinogen (Fg), functionally inactive forms of prothrombin (FIFP)), postthrombosis (D-dimer (D-d)) and anticoagulation (protein C (pC)) were determined depending on gender, hemodialysis experience, age, the presence of anemia, arterial hypertension (AH) and preserved residual renal function (RRF). Statistical processing of materials was carried out using methods of variation statistics using t-student criterion. It was found that violations in the hemostatic system are detected in almost all patients. At the same time, hyperfibrinogenemia, an increase in sF concentration, a deficiency of pC, less often an accumulation of FIFP and high levels of D-d are most often observed. These disorders of hemostasis are more often found in patients with absent RRF, a longer experience of hemodialysis, the presence of arterial hypertension and are less associated with gender, age of patients and are little dependent on the degree of anemia.

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.

STATUS OF PRO- AND ANTICOAGULANT COMPONENTS OF HEMOSTASIS IN PATIENTS WITH STAGE VD CKD DEPENDING ON RESIDUAL RENAL FUNCTION

The aim: To study the status of pro- and anticoagulant components of hemostasis in patients with stage VD CKD depending on residual renal function. Materials and methods: 88 patients with stage VD CKD were studied, 16 of them had preserved residual renal function (RRF). Hemostatic parameters - soluble fibrin, D-dimer and protein C - were determined in the patients. Results: Significant increase in soluble fibrin and fibrinogen levels along with depressive reaction of D-dimer and protein C were found in patients with stage VD CKD having lost RRF. Preserved RRF in those patients had positive influence on hemostatic profile, decreasing the degree of hypercoagulation. Conclusions: 1. In long term dialysis patients with stage VD CKD and lost RRF, significantly increased levels in soluble fibrin and fibrinogen along with decreased D-dimer concentration were found, being a key factor in the development of thrombotic complications. 2. There was significant decrease in protein C activity in patients with lost RRF. 3. Preserved RRF in patients with stage VD CKD had positive influence on hemostatic profile.

Possibilities of using hemostasis markers and parameters of hemostatic potential for predicting thrombotic complications in patients with CKD stage VD

Annotation. Violations in the hemostatic system of patients with chronic kidney disease (CKD) of the VD stage treated with program hemodialysis are associated with a high thrombotic risk. Comprehensive studies of the possible causes and predictors of thrombophilia can improve the therapeutic and prophylactic measures to combat thrombotic complications. The search for available methods for predicting these complications is very relevant. The goal is to develop a method for predicting the development of thrombotic complications in this category of patients, which would allow identifying the degree of hemostasis disorders. We examined 88 patients with CKD VD, treated with program hemodialysis, who determined the fibrinolytic potential and the level of soluble fibrin and D-dimer by enzyme immunoassay. It is proposed to use the developed fibrinolytic coefficient (Fc) to predict thrombotic complications. It was found that the proposed method for assessing hemostasis using Fc makes it possible to objectively characterize the state of the coagulation link and can serve as an indicator of thrombotic risk.

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.&#x0D; 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.&#x0D; 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.&#x0D; 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&lt;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&lt;0.001), end-diastolic LV dimension (p&lt;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&lt;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&lt;0.001).&#x0D; 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.

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.&#x0D; 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.&#x0D; Survival in observation groups was determined by the Kaplan-Meier method. Analyzed cases were included to October 31, 2018.&#x0D; 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.&#x0D; 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 &lt;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 &lt;0,05).&#x0D; 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.

Overall hemostasis potential of the blood plasma and its relation to some molecular markers of the hemostasis system in patients with chronic renal disease of stage VD

Overall hemostasis potential of the blood plasma and its relation to some molecular markers of the hemostasis system in patients with chronic renal disease of stage VD

Coagulation and fibrinolytic potential of blood plasma in patients with stage VD CKD, treated by program hemodialysis, as the markers of thrombotic risk

Thrombotic complications, associated with hemostatic system disturbances in patients with stage VD chronic kidney disease (CKD), occur rather frequently. Hence, the search of early available biological markers in diagnosis of this complication is of great significance. Objective – to study coagulation potential of blood plasma in patients with stage VD CKD, treated by program hemodialysis, and to determine the markers of thrombotic risk. 88 patients (aged 26–65) with stage VD CKD, treated by program hemodialysis, were studied. Hemostatic potential of blood was determined by spectrophotometry; soluble fibrin level — by two-site enzyme-linked immune-sorbent quantitative assay; D-dimer — by enzyme immunoassay using monoclonal antibodies to D-dimer epitopes; protein C activity — by spectrophotometry with wavelength 405 nm; fibrinogen contents — by spectrophotometry with wavelength 280 nm. Statistical processing was performed by methods of variation statistics and correlation analysis. All patients were found to have significant increase of soluble fibrin level (4.03±0.15÷4.62±0.31 mg/ml) (р &lt;0.001), but there was a group of patients (n=25), who demonstrated increased coagulation potential, (р &lt;0.001), significantly prolonged fibrinolysis (р &lt;0.001) and increased soluble fibrin concentration (5.36±0.61÷5.78±0.82 µg/ml) (р &lt;0.001) along with the tendency to decreased C protein level and no response of D-dimer to increased soluble fibrin level. Detected changes in coagulation properties of blood plasma can serve the markers of thrombotic risk. Thus, the patients with stage VD CKD, treated by program hemodialysis, have high risk of thrombosis, associated with high concentration of soluble fibrin and fibrinogen. But in this category of patients, rather low fibrinolytic potential, as well as the level of natural anticoagulant — C protein — is observed. The studied homeostatic parameters can be used as the markers of thrombotic risk.

The level of chorionic gonadotropin in postmenopausal women with CKD V stage treated with hemodialysis

The chorionic gonadotropin (CGT) test is used to diagnose and monitor the course ofpregnancy, including ectopic, to detect fetal abnormalities, trophoblastic diseases, preeclampsia, ovarian tumors, lungs, stomach, intestine, bladder, kidneys, prostate. The level of CGT is often elevated in postmenopausal women treated with hemodialysis (HD). Its significance is still not well understood, and therefore requires further study. The aim of our work was to investigate the level of CGT in postmenopausal women treated with HD.&#x0D; Methods. The determination of the level of CGT in 23 postmenopausal women treated with HD. The main inclusion criteria were as follows: oral informed consent of the patient to participate in the study, the presence of CKD stage VD and treatment of HD for at least 6 months. Exclusion criteria: severe functional disorders (liver, heart, respiratory failure), cancer processes, smoking, taking substitution hormonal therapy, lack of consent of the patient. The results were compared with the CGT levels in 20 healthy menopausal women (group II).&#x0D; Results. A statistically significant difference was found between the I group (postmenopausal women treated with HD) and II group (women without chronic kidney disease (CKD) (t = 3.62, p = 0.001). It was also found that CGT was increased in 9 (39%) of 23 women treated with HD. The norm of CGT in postmenopausal women is &lt;14.0 IU/L, therefore the deviation of the index in the I group (13.63 ± 2.83 IU/L) is within the reference values. However, it does not explain the statistically significant difference between the CGT indices in the I group compared to the II group (p&lt;0.01). Possibly, the presence of CKD contributes to the increase in HGT.&#x0D; Conclusions. Authentically higher rates of CGT in postmenopausal women treated with HD compared with women without CKD were detected. Thus, CKD can affect the serum level of CGT, probably due to disruption, but this issue has not been studied, and requires further investigation.

Study of therapeutic efficacy of febuxostat in chronic kidney disease stage IIIA to stage VD.

Hyperuricemia [serum uric acid (SUA) >7.0 mg/dL] which is common in chronic renal diseases is associated with augmented vascular events. In addition to nonpharmacological therapy, hypouricosuric drugs reduce UA levels. The current study was a prospective observational study of six months duration November 2016 to April 2017 done to determine the efficacy of febuxostat in patients with hyperuricemia in chronic kidney disease (CKD) stage G3a to G5 and to correlate any association with reduction of hypertension, improvement in glomerular filtration rate (GFR), and reduction in comorbidities. The study was carried out at the Department of Nephrology, Owaisi Hospital and Research Center, Hyderabad. One hundred and ten patients were screened, of which 53 patients wherein stage G3a to G5 were recruited and SUA levels were obtained after inclusion criteria. SUA >6.0 in females and 7.0 in males were recruited. The drug febuxostat 40 mg was given once day to all patients with stage G3a to G5D with elevate uric acid levels >7.0 in males and more than 6.0 in females and three samples of UA were obtained monthly. The mean of GFR, blood pressure (BP), and SUA levels were obtained before and after the therapy. Of the 53 patients, males were 32 (60.3%), and females were 21 (39.6%). Mean age of the patients were 36.5 years. Mean UA levels before the start of febuxostat therapy were 8.6, and after adding febuxostat, it was 5.10 at the end of the third visit. The mean BP drop was 7.2 ± 2.1 mm in systolic BP (from 154-147 mm Hg) and diastolic BP drop was 93 ± 2.5 mm Hg (5.1 mm Hg). The mean GFR improved from 50.3 to 53.3 mL/min after the start of febuxostat. Febuxostat in asymptomatic CKD patients improves UA levels, BP and estimated GFR at low dose without any adverse events and no cardiac-related events.

CHANGES OF NONESSENTIAL TRACE ELEMENTS LEVELS IN WHOLE BLOOD OF END STAGE RENAL DISEASE ADULT PATIENTS

Aims: Accumulation of trace elements occurs in conditions of decreased or termination of kidneys functions. In some conditions increased trace elements can obtain toxic features. On other hand, researches are showing that concentration of some trace elements could be decreased in ERSD patients, too. The most important factor affecting trace element concentration in ERSD patient is the degree of renal failure and using of replacement therapy.&#x0D; Materials and methods: We determined the concentration of microelements (beryllium, boron, aluminum, vanadium, chromium, nickel, arsenic, rubidium, strontium, cadmium, cesium, barium, thallium and lead) in whole blood of 41 ESRD patients with chronic kidney disease stage VD, who were treated with hemodialysis / hemodiafiltration and in 61 conditionally healthy donors. Determination of whole bloods trace elements content was conducted using inductive coupled plasma mass- spectrometry (ICPMS).&#x0D; Results: It is determinate that levels of beryllium, boron, aluminum, vanadium, chromium, strontium, cadmium, barium, thallium and lead is reliable increased in ESRD patients. Decreased levels are observed for nickel, arsenic, cesium and rubidium.&#x0D; Conclusions: ESRD is accompanied with substantial and multidirectional changes of trace elements blood levels. During researches has shown that in ESRD patients processes of trace elements accumulation are prevailing over elimination ones.