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The pancreas gland (PG) is a secondary product of livestock processing; it contains a wide range of biologically active compounds. The purpose of this article is to analyze the efficiency of technological approaches for pancreas gland extraction with the help of trehalose and a glycine-proline mixture aimed for recovery and separation of the gland’s protein-peptide compounds. The extraction was conducted with 0.9% NaCl, 0.9% NaCl, with addition of 0.5 M trehalose (0.9% NaCl-0.5 M trehalose) and 0.9% NaCl with addition of 1% glycine and 0.1 M L-proline (0.9% NaCl-1% Gly-0.1M Pro), the ratio of pancreas gland to extractant was equal to 1:5. The concentration of the protein in the supernatants after their extraction was measured by the biuret reaction in a semi-automatic biochemical analyzer Biochem SA. The proteomic composition of the extracts and the native pancreas gland was assessed by one-dimensional Laemmli electrophoresis in a 12.5% polyacrylamide gel and by two-dimensional O’Farrell electrophoresis. When determining the intensity of the protein fractions, it was noted that the methodology of separation of protein-peptide mixtures extracted from the pigs pancreas gland with the extractant 0.9% NaCl-1% Gly-0.1M Pro, ensured the higher extraction of the proteins in comparison with the method of 0.9% NaCl-0.5 M trehalose. Notwithstanding the fact that application of amino acids (glycine and proline) mixture provided for a greater yield of proteins from the extract into the diafiltrate, the experiments in vitro showed that the diafiltrate obtained though trehalose featured higher activity. This may be explained by the fact that after dialysis removal of trehalose from the protein fraction with a molecular weight of less than 50 kDa, its residual quantities were still sufficient to prevent proteins aggregation and, as a consequence, the biological activity of the extracted proteins was preserved, while in the diafiltrate obtained through amino acids mixture where numerous protein aggregates were detected by 2-DE. This study allowed testing the biotechnological methodics on pig pancreatic tissues aimed to intensifying the extraction and separation of protein compounds. The results of the study are important for development of methodological approaches to obtaining the targeted substances for their further utilizing for various purposes.

The purpose of the research is to analyze the dynamics of fenbendazole (FBZ) and niclozamide (NZM) release from their solid dispersions (SD) of various compositions by dialysis through various semipermeable membranes in model systems that correspond to stomach and intestine environments. To evaluate the parasitocidal activity of experimental mixture compositions.Materials and methods. The study used substances of FBZ and NZM, and the polymer, polyvinylpyrrolidone (PVP). Mechanical processes were carried out in a LE-101 roller mill and an AGO-2 orbital centrifugal mill at different power density levels. The resulting SD of various compositions were studied for solubility. The dynamics of FBZ and NZM substance release from the SD were studied in a laboratory setup consisting of a temperature controlled glass with buffer solutions with pH = 9.18 (intestinal environment) and pH = 1.0 (stomach environment). The substance concentration in the dialysate was determined by HPLC and UV spectroscopy. The resulting complex SD of FBZ and NZM were studied for cestodocidal activity in a laboratory model of hymenolepiosis of white mice.Results and discussion. It was found that the substances release into a buffer solution with pH = 9.18 from the SD obtained in the roller mill is higher than that of the SD obtained in the AGO activator. The dialysis of the experimental compounds in a model system with a gastric juice medium observed only FBZ substance penetration through the membrane, which can be explained by protonation of the FBZ molecule which is a weak base. The NZM molecule, being a neutral molecule, does not penetrate through the semi-permeable partition into the hydrochloric acid environment; it remains entirely inside the dialysis bag. High anthelmintic efficacy rates (up to 100%) of SD complex FBZ : NZM : PVP obtained in the AGO activator and in the roller mill were recorded for the SD of composition 2 : 20 : 78 in the mice with hymenolepiosis. The activity of the base drug, the niclozamide substance, was 27.69%, which is 3 times lower than the activity of the resulting complex dispersions.

Introduction: The main causes of chronic kidney disease (CKD) are diabetic and hypertensive nephropathy. The incidence of civilization diseases is increasing, which also indirectly affects the increase in the incidence of CKD. The patient's therapy after the diagnosis should include the care of a multi-specialist therapeutic team that will remove as many restrictions as possible in everyday functioning and ensure a high quality of life. In addition to the selection of individual renal replacement therapy, i.a. physical rehabilitation. Despite the fact that in the course of chronic kidney disease physical activity is impaired by numerous pathophysiological processes, the patient should be encouraged to undertake physical activity in order to reduce the risk of death due to cardiovascular diseases, as well as to eliminate many other adverse health effects of the disease. The following paper aims to analyze the impact of physical activity on CKD patients and the pathophysiological causes of low physical activity in this group of patients and the possibility of implementing rehabilitation as an element of comprehensive therapy. Aim of the study: To review the current literature on the physical activity of patients with chronic kidney disease Materials and Methods: A review of the publications available in PubMed, using the key words „chronic kidney disease”, „psychical activity in chronic kidney disease”, physical activity”, „kidney failure”, „dialysis”, „renal rehabilitation”, „quality of life”

Background. Diabetic nephropathy (DN) is a specific kidney lesion in patients with diabetes mellitus, which leads to the development of endstage kidney disease and requires substitutive renal therapy (dialysis or transplantation). Canagliflozin is a sodium-glucose co-transporter 2 (SGLT2) inhibitor, which exerts a renoprotective effect. According to the published data, the application of canagliflozin in patients with type 2 diabetes mellitus (DM2) and DN could postpone dialysis therapy for almost 13 years.Objective: to perform a long-term analysis of canagliflozin budget impact in adult patients with DM2 and DN from the point of view of the constituent entities of the Russian Federation.Material and methods. A group of comparison for canagliflozin was placebo (no renoprotective pharmacotherapy). The authors proposed a mathematical model for DN progression in groups of patients who received canagliflozin (100 mg orally, daily, long-term) or placebo. The model was based on the extrapolation of the CREDENCE study data. The model was used for the analysis of the direct costs on the lifetime pharmacotherapy and dialysis per one patient. Epidemiologic data from the federal register on the number of adult patients with DM and DN prevalence among these patients were used to evaluate the size of the target population. Based on the clinical recommendations and the medical care standards for patients with DM and the data on the actual state procurement of SGLT2 inhibitors and glucagon-like peptide-1 receptor agonists in 2021, we evaluated the share of patients with DM2+DN who currently do not receive renoprotective therapy but who must be supplied with canagliflozin according to the standards. Among this population, we determined the patients with the glomerular filtration rate within 30–90 ml/min/1.73 m2, which provides the comparability of the target population with patients included in CREDENCE clinical study.Results. Direct medical costs per one patient receiving canagliflozin therapy were 678 108 rubles, which was 52.8% (759,239 rubles) lower than without renoprotective pharmacotherapy (1,437,347 rubles). As a result, considering the modeling period and current practice, the budget costs for pharmacotherapy of patients with DM2+DN were 99.82 billion rubles, in comparison with the proposed practice, which was 47.09 billion rubles (difference in budget costs is 52.73 billion rubles, or 52.8%). The accumulated costs of the regional health care system were lower in patients receiving canagliflozin in comparison with patients without renoprotective pharmacotherapy 11 years after the beginning of treatment.Conclusion. The expansion of canagliflozin application in the therapy for patients with DM2+DN leads to the budget cost cuts in the long run due to the extension of the dialysis-free period.

The review presents data on the effect of program hemodialysis on the state of intraocular pressure in patients with terminal chronic renal failure. Treatment with hemodialysis is accompanied by various effects: from intraocular pressure drop to the development of ophthalmic hypertension with pain syndrome. The state of the iris-corneal angle, neovascularization of the structures of the eye drainage system and the presence of glaucoma are significant, but not indisputable, risk factors for pain-related dialysis ophthalmic hypertension. Their combination with the effect on the osmolar balance of dialysis therapy increases the possibility of the formation of ocular hypertension syndrome formation. The need to eliminate dialysis eye pains and the chance of glaucoma progression due to dialysis-affected fluctuations of intraocular pressure remains relevant.

Aim. To evaluate the prevalence of arrhythmias in patients undergoing chronic hemodialysis, to characterize the arrhythmia types in relation to the dialysis procedure and to determine their relationship with clinical findings and echocardiographic characteristics.Material and methods. The study involved 152 patients with kidney failure undergoing chronic hemodialysis. All patients underwent an assessment of dialysis parameters, collection of clinical data, and 48-hour Holter monitoring. In addition, 93 patients underwent an echocardiography with an assessment of left ventricular (LV) mass index, LV ejection fraction, left atrial (LA) volume index, E/e’, cardiac output and preload, which was defined as increased LV filling pressure (E/e’ >12) and LA enlargement (LA volume index >30 ml/m2).Results. Among the 152 examined patients, premature supraventricular and ventricular contractions (PVCs) were observed in almost all patients, while 41% had paroxysmal supraventricular tachycardia. Clinically significant arrhythmias included persistent atrial fibrillation (AF) in 8,6% of patients, paroxysmal AF in 3,9%, nonsustained ventricular tachycardia in 19,7%, bradycardia in 4,6%, second-degree atrioventricular block in 1,3% and third-degree atrioventricular block among 2,6%. PVCs were more common on dialysis days, while tachyarrhythmias were more common during dialysis and in the immediate post- dialysis period. Older age (odds ratio (OR) 10 years older, 1,53; 95% confidence interval (CI): 1,15-2,03; P=0,003), lower cardiac output (OR 1 L/min more, 0,66; 95% CI: 0,44-1,00; P=0,05) were independently associated with clinically relevant arrhythmias.Conclusion. In patients on chronic hemodialysis, older age, increased preload and lower cardiac output are independently associated with clinically relevant arrhythmias. In addition, a positive association between increased LV mass index and AF episodes has been demonstrated. Lower cardiac output had positive correlation with AF and ventricular arrhythmias.

Home hemodialysis (HHD) is a discovery from 1961 that is now experiencing a revival. It is a convenient and modern method of renal replacement therapy that allows the patient to undergo hemodialysis sessions at home. Due to the growing interest in home hemodialysis, we decided to present the potential of this renal replacement method, show both its benefits and complications resulting from its use. Undoubtedly, HHD has many benefits resulting mainly from the possibility of regulating the duration of the sessions and increasing their frequency. However, this method is also burdened with numerous complications. There are training courses in the use of HHD for patients who have just been diagnosed with end-stage renal disease as well as for patients undergoing dialysis using other methods. Appropriate patient selection is an important factor for the success of home therapy. There is a fierce battle in the home hemodialysis machine market. Manufacturers are outdoing each other in innovative technologies to ensure ease of use, trouble-free operation and minimize complications. The costs of home hemodialysis include more components than the dialysis treatment itself. Home hemodialysis gives patients comfort and independence above all. This is part of nephrology that undoubtedly requires a lot of work and development, but is certainly an invention of the 21st century.

Chronic kidney disease (CKD) in high-risk pregnancies is a challenge for multidisciplinary teams of doctors. Due to the fact that the disease affects both the mother and the fetus, and the course of the pregnancy. The following article reviews the literature about the interaction between pregnancy and CKD and dialysis therapy. Even pregnancy itself can lead to a worsening of kidney dysfunction. The risk of this consequence increases with the degree of renal failure, therefore renal parameters and other pregnancy test results should be monitored. On the other hand, the most common complications of chronic kidney disease in pregnancy described in the literature include pre-eclampsia, preterm labor, intrauterine growth restriction (IUGR) or low birth weight, surgical delivery by caesarean section and miscarriage. Dialysis therapy also leads to abnormalities in the course of pregnancy, and patients require constant monitoring during its course. Attention is also drawn to the high percentage of newborns requiring intensive postpartum care. Due to the risk for the fetus and mother mentioned in the article, nephrologists and gynecologists should cooperate closely from the pre-contraceptive period in order to reduce the risk of sequelae and better control of the underlying disease.

Introduction and methods Artificial Intelligence(AI) is a relatively new branch of science that studies the display of intelligent behavior by machines and its use in advanced analysis and computation. Due to the potential use of AI, it has also been introduced into medicine and nephrology. The following article is an analysis of the current knowledge on the potential of AI in nephrology and its relevance to clinicians based on the latest publications contained in the PubMed and Google Scholar databases. Stage of knowledge AI found its application in the prognosis of the development of IgA nephropathy thanks to the use of a neural network, which by analyzing the results of research and the drugs used in a large group of patients has learned to detect patients at high risk of developing severe complications at the beginning of the disease. What is more, AI makes it possible to detect DKD earlier and delay renal replacement therapy. In patients undergoing hemodialysis, artificial intelligence developed a model that calculated the appropriate duration of the procedure and adjusted drugs to control blood pressure. Another example of the use of AI is its use in relation to patients undergoing kidney transplantation. The AI calculates the beneficial concentration of an immunosuppressive drug specifically for a given patient, which allows clinicians to limit adverse effects. Summary AI is a breakthrough technology that is constantly being developed. Despite the high cost of implementing this technology, it is believed that it could represent the future of medicine and be a new way in treatment techniques and in the early detection of diseases in nephrology.

Aim. Supraventricular arrhythmias (SVA) are associated with high morbidity and mortality. However, little attention is paid to this condition in patients undergoing hemodialysis. The aim of this study was to analyze the long-term relationship of intradialytic SVA, including asymptomatic arrhythmias, with adverse events in a cohort of patients undergoing hemodialysis.Material and methods. An observational prospective study was conducted in a group of patients on hemodialysis with a 10-year follow-up. The study involved 77 patients (42 men and 35 women; mean age 58±15 years) with sinus rhythm, then they were monitored for ECG for six consecutive hemodialysis sessions during recruitment.Results. Arterial hypertension was present in 68.8% of patients, diabetes mellitus in 29.9% of patients. SVA were reported in 38 patients (49.3%); they all had a short-term, asymptomatic character and were terminated independently. Age (hazard ratio [HR] 1.04 per year; 95% confidence interval [CI] 1.00-1.08) and an increase of the atrium (HR 4.29; 95%CI 1.30-14.09) were associated with supraventricular arrhythmia in multidimensional analysis. During an average follow-up of 40 months, 57 patients died, and cardiovascular diseases were the main cause of death (52.6%). Variables associated with all-cause mortality in the Cox model were age (HR 1.04 per year; 95%CI 1.00-1.08), C-reactive protein (HR 1.04 per 1 mg/l; 95%CI 1.00-1.08) and supraventricular arrhythmias (HR 3.21; 95%CI 1.29-7.96). Patients with supraventricular arrhythmias also had a higher risk of nonfatal cardiovascular events (HR 4.32; 95%CI 2.11-8.83) and symptomatic atrial fibrillation during observation (HR 17.19; 95%CI 2.03-145.15).Conclusions. Strong relationships have been established between the presence of supraventricular arrhythmias recorded during ECG during dialysis and symptomatic AF developing in the future. Patients with supraventricular arrhythmias had a larger right atrium. Age and supraventricular arrhythmias are the main variables associated with mortality in dialysis patients.

Relevance. Supraventricular arrhythmias are frequent comorbid conditions in patients with end-stage renal failure undergoing dialysis. The prevalence of atrial fibrillation (AF) in this group of patients is higher than in the general population and is associated with increased mortality. Aim. To analyze the effect of a dialysis session on echocardiographic parameters and to assess their relationship with the occurrence of supraventricular arrhythmias and AF during hemodialysis. Material and methods. The study included 78 patients on hemodialysis. All patients underwent Holter electrocardiography monitoring, taking into account the heart rate before and after dialysis, the number and duration of AF episodes associated with the dialysis session. Using echocardiography, which was performed before and after the dialysis procedure, all patients were also evaluated for the presence of left ventricular (LV) hypertrophy, impaired systolic and diastolic function, as well as LV myocardial mass, sizes of the left atrium, its volume, volume of the right atrium and LV ejection fraction. Results. An analysis of the differences in echocardiographic parameters before and after dialysis showed a significantly larger volume of the left atrium, the volume of the right atrium, the width of the inferior vena cava, and the parameter P(early transmitral velocity) before dialysis compared with the state after dialysis. Also, AF paroxysms were recorded much more frequently after dialysis. The volume of the left atrium 32 mm and the right atrium 30 mm (limit values) were observed much more often in patients before dialysis. A relationship was found between an increased number of paroxysms of atrial fibrillation and a decrease in the volume of the right atrium 5 mm and the left atrium 7 mm after dialysis. No correlation was found between the mass of the LV and the volume of the left atrium. Conclusions. 1. The age and duration of dialysis therapy in hemodialysis patients are associated with an increased risk of atrial fibrillation. 2. A decrease in the volumes of the right and left atriums after the hemodialysis procedure has a positive correlation with paroxysmal AF. 3. The hemodialysis procedure leads to a decrease in the volumes of the right and left atriums, as well as the width of the inferior vena cava and a decrease in the speed of movement of the mitral valve in early diastole. 4. No relationship was found between the volume of the left atrium and the mass of the LV myocardium in patients on hemodialysis.

Mineral-bone disorder in chronic kidney disease (CKD-MBD) is one of the most important factor determining prognosis in dialysis patients. CKD-MBD syndrome occurs at the CKD stage 2 and reaches its maximum in patients with end-stage renal disease. Currently, hyperphosphatemia plays a central role in the pathogenesis of CKD-MBD(the so-called “phosphate-centric paradigm”). In turn, hyperphosatemia leads to an increase in the level of phosphaturic hormone - fibroblast growth factor type 23 (FGF23). FGF23 causes remodeling and fibrosis of the myocardium, renal parenchyma, the development of calcification and vascular atherosclerosis. Thus, hyperphosphatemia, indirectly, through an increase in the level of FGF23, is one of the most important manifestation of progressive CKD and a significant factor of high overall and cardiovascular morbidity and mortality in this cohort of patients. Given that cardiovascular events are the main cause of mortality in patients on renal replacement therapy with dialysis, correction of hyperphosphatemia is a prerequisite for successful monitoring of this group of patients and influencing prognosis. The review presents the main approaches for the correction of hyperphosphatemia in CKD, such as nutritional correction, modification of dialysis methods, and prescribing of phosphate binders. The advantages of calcium-free phosphate-binding agents are considered in details and had compared with effects of containing calcium phosphate binders.The treatment of hyperphosphatemia should be approached comprehensively, using optimal dialysis therapy regimens, training and monitoring dietary phosphate consumption with the obligatory use of phosphate binders that are most effective and well tolerated.

COVID-19 poses a real threat to patients with comorbid conditions such as diabetes mellitus (DM), hypertension, cardiovascular, renal or hepatic disorders. Kidney damage is very likely in people with diabetes who have undergone a new infection, and the risk of developing acute renal injury is associated with mortality. Potential mechanisms of kidney involvement in the clinical picture of the disease may include cytokine damage, cross-organ damage, and systemic effects that determine the treatment strategy. These mechanisms are closely interrelated and are important for individuals on extracorporeal therapy and kidney transplants. Autopsy data provide evidence of SARS-CoV-2 virus invasion into kidney tissue with damage to tubular epithelium cells and podocytes, and red blood cell aggregation in severely COVID-19 patients. By including individuals with chronic kidney disease in planned COVID-19 research protocols, an evidence base for effective and safe treatments can be generated.

The issues of diuretic therapy in patients with chronic kidney disease, pharmacokinetics of diuretics, the problem of diuretic resistance, the tactics of using thiazides and loop diuretics in patients with various stages of chronic kidney disease, according to the recommendations of the National Kidney Foundation Kidney Disease Outcomes Quality Initiative are discussed in the article. Particular attention is paid to the prescription of this group of drugs to patients with end stage renal disease, as well as those undergoing renal replacement therapy (hemodialysis).Diuretics play an important role in the management of patients with chronic kidney disease with the development of hypertension and an increased extracellular fluid volume. In case of impaired renal function leading place is given to loop diuretics. Their combination with thiazide diuretics can increase the diuretic effect. The results of clinical trials assessing the effectiveness of the use of diuretics during decline of residual renal function are provided. It is reported about the effect of potassium-sparing diuretics on the incidence of cardiovascular complications, the development of hyperkalemia in patients undergoing dialysis treatment. The importance of continuation of intensive study about the possibility of antagonists of mineralocorticoid receptors usage, in particular the spironolactone, eplerenone, and finerenone in order to reduce cardiovascular complications and mortality, is indicated.

Background: Hemodialysis is the most common method of renal replacement therapy (RRT), however, its use is associated with risk of catheter-associated bloodstream infections (CABSI). Aims: diagnosis of epidemic trouble on CABSI in multidisciplinary adult hospital associated with the epidemic outbreak of CABSI in patients in RRT, and evaluation of complex of anti-epidemic measures. Materials and methods: in the framework of risk-oriented epidemiological surveillance retrospective and operational epidemiological analysis of morbidity of CABSI and integrated clinical-epidemiological and microbiological examination of cases of outbreak was carried out. The study included patients with central venous catheter (n = 1295), patients receiving renal replacement therapy (n = 235), patients with CABSI (n = 48). 47 S aureus strains were studied, 520 researches were conducted. Results: An outbreak of CABSI of staphylococcal etiology (morbidity 33.01 per 1000 catheterized patients, 95% CI 21.31–44.71), had occurred from September to October 2016, involving 4 departments, manifested as 7 cases of CABSI in patients with RRT and actively identified 4 cases asymptomatic carriers of S. aureus in patients and one staff member of the Office of dialysis (incidence rate – 33.01 per 1000 catheterized patients, 95% CI 44.71–21.31). Sources of infection have served as carriers of S. aureus among patients and staff. Contact pathway of transmission. Place of infection – dialysis department. Cause of the outbreak was the infection of patients in the RRT the hospital S. aureus strain circulating in this hospital with contamination of environmental objects and the formation of a reservoir among personnel and patients. To eliminate the outbreak, a set of measures was carried out, including optimization of monitoring of invasive manipulation of central venous catheterization, elimination of violations of epidemiological safety requirements, disinfection regime change, biological disinfection by bacterial phagocyte, decolonization of S. aureus carriers by bacterial phagocytes. The incidence rate decreased 1.8 times in 2017 compared to 2016, respectively, 12.5 per 1000, 95% CI 10.23–14.77) vs 22.8 per 1000 (95% CI: 22.5–23.1) of catheterized patients. Conclusion: the epidemic outbreak of CABSI in multidisciplinary hospital was identified and eliminated, The outbreak was the result of the circulation in the hospital of S. aureus hospital strain, which formed a reservoir among personnel and patients.

Atypical haemolytic uremic syndrome (aHUS) is an extremely rare pathology with the development of complement-mediated thrombotic microangiopathy (TMA). Before eculizumab, a humanized IgG monoclonal antibody to the complement component C5, the prognosis of total and renal survival with aHUS was unfavourable due to the high probability of death and the development of end-stage chronic renal failure in surviving patients. This article presents a clinical observation of a patient with aHUS who had an identified heterozygous factor H (CFH) mutation — c.3653G>A(p.Cys1218Tyr), and two heterozygous variants of polymorphism in the same gene — c.2016A>G; c.2808G>T. Despite the achievement of haematological remission of TMA against the background of plasma therapy, the child developed dialysis-dependent renal failure. Treatment with eculizumab in a patient with chronic kidney damage provided a significant improvement in their function, maintaining a stable remission and improving the quality of life of the patient with aHUS.Kh. М. Emirova, Е. S. Stolyarevich take part in educational events for doctors as lecturers with the support of Alexion Pharma. The other contributors confirmed the absence of a reportable conflict of interest.

Studies of the osmotic activity of emoxypine and dalargine ophthalmic experimental gels samples based on various polymers and also studies of some marketed in Russia ophthalmic gels are presented in the article. Selection of the most promising for further study emoxypine and dalargine experimental gel compositions was based on the comparative study of Vidisic®, Solcoseryl®, Corneregel®, Oftagel® ophthalmic gels as well as 0,9% sodium chloride solution used as the standard of osmolality. Optimal values of osmotic activity have an experimental sample of an emoxypine ophthalmic gel containing Natrosol™ 250HHX at a concentration of 1%, as well as Oftagel® and Solcoseryl® gels.

Sleep disorders are a significant problem in the dialysis patient population. They range from 30 to 80% of patients with kidney disease. Sleep submergers carry a wide range of consequences, both psychological and somatic. Obstructive sleep apnea, restless legs syndrome, excessive daytime sleepiness and insomnia are the most common sleep disturbances among dialysis patients. The aim of the study was to analyze the conditions and the most frequently occurring sleep disorders in patients with chronic kidney disease, dialyzed based on the subject literature review. Sleep disorders are both quantitative and qualitative. They carry numerous negative effects in the sphere of mental and somatic health of the patient, they decrease the overall quality of life. They heighten the already increased cardiovascular risk in the dialysis population. Therefore, early recognition and treatment of sleep disorders in dialysis patients is important. Periodic assessment of the sleep quality of a dialysis patient should be included in the therapy standard.

At present, much attention is paid to the study of the influence of gut microbiota on the development of many diseases of internal organs, including chronic kidney disease. Thus, changes of gut microbiota in the qualitative and quantitative composition toward increasing the proteolytic flora, which is the source of the formation of uremic toxins, endotoxinemia, systemic inflammation, secondary immunodeficiency and cardiovascular complications, contribute to the worsening of the course and the progression of chronic kidney disease. That why the use of medicines which normalize gut microbiota, is the significant aspect of preventing the progression of chronic kidney disease.

The article presents the contemporary views of the role of aldosterone in the progression of cardiovascular and renal diseases. It addresses matters related to the efficacy and safety of mineralocorticoid receptor antagonists in patients with chronic heart failure, chronic kidney disease at various stages including terminal renal failure, dialysis therapy, and kidney transplantation.

Replacement renal therapy is the only method for treating the terminal stage of chronic renal failure before kidney transplantation, if such one is possible. In recent years, the frequency of outpatient peritoneal dialysis, conducted both in a hospital and at home, has increased for this purpose in children. The efficacy of dialysis and minimization of complications, especially peritonitis, depend not only on the program chosen by a doctor but also on the correct execution of the procedure and the observance of aseptic and antiseptic rules by persons performing dialysis (nurse and mother). The article introduces the basic principles of dialysis: demonstrating the role of a nurse in the procedure, the author justifies the need to improve knowledge in the field of renal replacement therapy in order to intelligently and easily explain the essence of dialysis to a mother and teach her how to perform the procedure independently.

End-stage of chronic kidney disease adversely affects fetal and maternal outcomes during pregnancy. The last few years, advances in our knowledge about the interaction of pregnancy and renal function resulted in the improvement of fetal outcome in patients with chronic renal failure and also in the management of pregnant women with end-stage renal disease maintained on dialysis.

Purpose: studying of endotoxin antibodies level of classes G, M, A and level of C-reactive protein at patients on a programhemodialysis and a constant peritoneal dialysis.Materials and methods:16 patients with a chronic kidneys disease 5 stage on a peritoneal dialysis and 62 patients on a program hemodialysis are surveyed. Level endotoxin antibody classes G, M, A, and C-reactive protein was determined by ELISA.Results: it is established that patients on a peritonial dialysis have level anti-ET-IgG in 4.9 times in comparison with group of conditionally healthy patients, and levels anti-ET-IgA and anti-ET-IgM didn’t differ from norm indicators. Also increase of level of C-reactive protein in 8.8 times, in comparison with indicators of healthy donors. At patients on a program hemodialysis increase in 5.6 times anti-ET-IgG, and in 8 times of C-reactive protein in comparison with group of healthy patients. And levels anti-ET-IgA and anti-ET-IgM also didn’t differ from norm indicators. Levels of endotoxin antibodies and C-reactive protein at patients on a hemodialysis and on a peritonial dialysis among didn’t differ.Conclusion: in both groups of patients found an increased antibody response to ET (on a high level of anti-ET-IgG) against the background of a high level of systemic inflammation (at the level of C-reactive protein). There is chronic endotoxin aggression in hemodialysis patients.

results of clinical trials demonstrate that selective vitamin D receptor agonist paricalcitoldecreases proteinuria in patients with chronic kidney disease (CKD) and hyperparathyreosis.

Dialysis-related amyloidosis (DRA) is a serious complication arising in the context of long-term hemodialysis or continuous ambulatory peritoneal dialysis. DRA predominantly involves the osteoarticular system and is clinically manifested by erosive and destructive osteoarthropathies and carpal tunnel syndrome. The aim of this study was to establish distinguishing features of the DRA in dialysis patients by using ultrasound. Joints and soft tissues of 200 patients with chronic kidney disease receiving dialysis were studied by ultrasound. Fourteen patients (7,0%) had clinically and radiologically evident, biopsy proven DRA. In this group of patients, all patients were receiving hemodialysisfor an average of 168 months. There was positive correlation found between dialysis duration and presence of DRA (Rs = 0,667; p < 0,001). The relationship between presence of DRA and discovered joints changes using ultrasound is analyzed. More frequent involvement in the pathological process shoulder (92,9%) and hip joints (64,3%) was noted. There were statistically significant differences in rotator cuff thickness and hip joint anterior synovial space thickness in patients with DRA compare to general group (p < 0,001). Ultrasound is a highly informative method of diagnosing DRA in patients with end-stage renal disease. It provides detailed soft tissue and joint description substituting other imaging modalities.

Aim. To estimate the requirement of the population of the Russian Federation for an organ transplantation and donor resource, to offer approach to planning of an effective network of the medical organizations (the centers of transplantation). Materials and methods. The analysis and comparison of statistical data on population, number of the patients receiving a dialysis, data about medical care on an organ transplantation in Russia and foreign countries is made. Results. On the basis of what the assessment of requirement of the population of the Russian Federation in an organ transplantation and donor resource is carried out, approach to planning of an effective network of the medical organizations (the centers of transplantation) and scenarios of development of organ do- nation and transplantation in Russia is offered. Conclusion. To provide the population of the Russian Federation with medical care on an organ transplantation according to real requirement and donor resource, in each region of the Russian Federation have to be organized deceased organ donation and transplantation of a cadaveric kidney. But the transplantation of extrarenal organs is better to develop in the federal centers of hi-tech medical care with donor providing from territories of adjacent regions.

The paper presents a concept of formation and development of interregional, regional, and equated centers, interregional specialized units set up on the basis of therapeutic-and-prophylactic institutions on the basis of a multileveled multistage health care system. Large multidisciplinary clinical hospital One (Novokuznetsk) was used as an example to consider the mechanism of integration of innovation technology of organizing a specialized medical aid. Analysis of the needs of the region’s population for dialysis care for patients with acute and chronic renal failure has revealed the barest necessity of setting up a regional hemodyalisis center under a multidisciplinary clinical hospital. The setting up of a hemodialysis center substantially has quantitatively and qualitatively improved health care delivered to patients with acute and chronic renal failure.

Chronic kidney disease (CKD) is characterized by poor outcomes, an increasing frequency of new cases, the need for expensive method of renal replacement therapy at the terminal stage. The main task facing the doctor is slowing the progression of CKD and delay the start of dialysis by applying the nephroprotective strategy, of which diet therapy is an essential part. The key components of the diet for CKD patients are reducing sodium intake to 2.3 g per day in order to improve control of blood pressure (BP), dietary protein restriction adequate to renal function from 0.8 to 0.3 g/kg of body weight per day combined with the prescribing of ketoanalogues of essential amino acids, hyperglycemia control. With the progression of CKD, the main objectives of the diet therapy are the prevention/correction of complications: protein-energy waisting, metabolic acidosis, ensuring sufficient calories, corresponding to the bodys energy expenditures (3035 kcal/kg of body weight per day), limiting phosphate intake to 0.81 g a day, restriction of food potassium. Low-protein diet in combination with ketoanalogues of amino acids, regular monitoring and correction of the nutritional status of patients at the pre-dialysis stages of CKD is an effective and safe method of nephroprotection, which allows delaying the start of dialysis.

Analysed herein are the results of treating a total of 29 patients presenting with stage IV chronic kidney disease (CKD) induced by ischaemic nephropathy. All patients had renal artery stenosis more than 80%, decreased glomerular filtration rate (GFR) below 30 ml/min/1.73m2 and were regarded by the nephrologists as potential candidates for programmed haemodialysis. After preparation aimed at preventing contrast-induced nephropathy all patients underwent stenting of the stenosed renal arteries. In the early postoperative period, 21 patients were found to have stabilization of the GFR with a tendency to increase. One woman developed acute renal failure requiring renal replacement therapy by means of haemodialysis. During the follow-up period from 1 to 5 years, 26 patients showed no progression of azotemia. CKD changed to stage III in 15 patients (p<0.005). Twenty-three (84%) patients during the follow-up period developed no new cardiovascular events. Hence, performing renal revascularization for renal artery stenosis >80% revealed in patients with stage IV CKD promotes prolongation of the dialysis-free period.