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BACKGROUND: Chronic kidney disease (CKD) is a common end-stage disease requiring kidney transplantation or dialysis, which main type is program hemodialysis (PHD). These high-cost technologies of renal replacement therapy have significantly improved over recent decades, but the quality of life remains low and mortality is still high, especially in patients receiving PHD. Currently, a number of parameters associated with poor prognosis have been identified, including skin autofluorescence (SAF), an affordable method to detect glycation end products (glycotoxins) in tissues, which claims to be an integral biomarker. AIM: To assess relationship of SAF with clinical and metabolic status parameters in patients receiving renal replacement therapy. MATERIALS AND METHODS: The study included 88 patients receiving PHD and 27 transplanted kidney recipients (TKR). The measurements were performed using the original SAF reader. RESULTS: SAF was significantly higher in TKR and patients receiving PHD. A universal, pronounced relationship of SAF with age and smoking was found in the control, PHD, and TKR groups. Models of SAF determinants in each studied group were proposed. SAF was associated with malnutrition stages (by NRI; r=−0.39; p 0.001), the Charlson comorbidity index (r=0.60, p 0.0001), and inflammatory activity based on C-reactive protein in the PHD group (r=0.32, p 0.01). CONCLUSION: Models of SAF determinants in each studied group were proposed. Furthermore, highly significant direct correlations with left ventricular hypertrophy and its negative ejection fraction were established in this group. These facts suggest that SAF is an integral parameter of cardiac remodeling and metabolic profile, primarily in patients receiving PHD, which promotes it as a prognostic parameter.

The study showed that the eccentric myocardial hypertrophy predominates in the group of patients receiving hemodialysis, which is mainly due to volume overload of the left ventricle, while in the kidney transplant recipients group, in the vast majority of cases, concentric hypertrophy of the left ventricle is detected due to the predominance of pressure load on the heart. Therefore, the type of remodeling of the left ventricle in patients with terminal renal failure can be determined by the type of renal replacement therapy.

The number of dialysis patients is increasing every year and is estimated to be more than 2 million, with an annual increase of 6–12% in dialysis programs. There is a high correlation between cognitive impairment and mortality in dialysis patients, which suggests the relevance of screening cognitive functions in dialysis patients using different neuropsychological scales.Aim of the study was to test the cognitive status and identify cognitive impairment in patients with terminal stage of chronic kidney disease treated using program hemodialysis, as well as to evaluate risk factors for cognitive impairment in this category of patients.Material and methods. 83 patients aged 28 to 78 years (mean age 56.7±13.7 years) were examined. The main group included 53 people who received program hemodialysis, of them 23 men and 30 women. The mean age of patients in this group was 58.3±13.3 years. The control group composed of 30 individuals without kidney diseases, including 13 men and 17 women. The mean age in the control group was 53.6±14.9 years. The MoCA and SLUMS scales were chosen for detecting cognitive impairment and assessment of neuropsychological status. We used mathematical methods of research data processing such as inductive statistics and correlation analysis.Results. Cognitive impairment was found to be significantly more frequent in dialysis patients (75.5–81.1% of cases, P=0.05) compared to those without kidney pathology. The SLUMS scale was shown to be more sensitive than MoCA (P=0.05, CI 95.0%). The risk factors of cognitive impairment in dialysis patients included increased dialysis duration, age (rs=–0.298) and low estimated urea dialysis adequacy index (Kt/V less than 1.2).Conclusion. A high risk of cognitive impairment is common in dialysis patients. For its timely detection, the screening neuropsychological test are recommended to be used by clinicians. Cognitive impairment, diagnosed by the tests, is an indication for a specialist consultation.

Coronavirus infection (COVID-19) is an acute infectious disease caused by a new strain of the virus of the genus coronavirus SARS-CoV-2 with the aerosol-droplet and contact-household transmission mechanism; patogenetically local and systemic inflammatory process, hyperactive impulsive cascade, endotheliopathy, hypoxia, leading to the development of micro – and microthrombosis; it occurs from asymptomatic to clinically significant forms of intoxication, vascular lesions, lungs, heart, kidneys, and GI tract with risk of complications (ARF, ARDS, sepsis, shock, multiple organ dysfunction SYNDROME, pulmonary embolism). Currently, there are few data on the course of this disease in patients undergoing treatment with program hemodialysis, as well as methods of specific treatment of this group of patients. The article describes the case of the first patient in the Clinical Infectious Hospital named after S.P. Botkin with end-stage chronic kidney disease corrected by program hemodialysis, who had a COVID-19.

Background. Today, the programmed hemodialysis belongs to the clinical medicine area where patients are at a constant risk of viral hepatitis infection. This is associated with surgical interventions on the vessels, fairly frequent transfusions of blood components, and regular hemodialysis procedures. But in recent years, the ratio of reported cases of viral hepatitis B and C in patients on programmed hemodialysis has changed significantly. With an abrupt increase in the incidence of viral hepatitis C, there is a decrease in the number of registered viral hepatitis B cases.The aim. To study the clinical, epidemiological and pathogenetic features of viral hepatitis C in hemodialysis units.Material and methods. A multicenter study was conducted that enrolled the patients from the Programmed Hemodialysis Units in Tashkent and the regional departments of the Republic of Uzbekistan. The study involved 395 patients on programmed hemodialysis for 7.5 ± 0.7 years. The age of patients was 43.5 ± 0.91 years. The diagnosis of chronic viral hepatitis C was made on the basis of medical history, clinical and laboratory data, and detection of anti-HCV IgG and RNA-HCV in blood.Results. When analyzing the clinical examination and laboratory test results of 395 patients, the parenteral viral infection markers were detected in 181 patients (45.8%). The analysis of the overall incidence of viral hepatitis showed that chronic viral hepatitis C had the highest rates and was found in 125 patients (31.6%). The analysis of the chronic viral hepatitis C course in the presence of the end-stage chronic renal disease showed that in 11 (34%) of 32 patients of the Main group the disease proceeded as a fulminant form of chronic renal-hepatic failure with the development of adverse outcomes. Twenty seven patients (84%) in this group developed progressive anemia. In 16 patients (50%), persistent polyserositis developed in the form of hydrothorax, ascites, and pericarditis, which reflected the aggravating effect of chronic viral hepatitis C on the course of chronic renal disease.Conclusions. In Hemodialysis Units, both in the city of Tashkent, and in the regional departments of the Republic of Uzbekistan, the incidence of chronic viral hepatitis C prevails, having the form of a pathological process with a minimally low activity. Chronic viral hepatitis C has an aggravating effect on the course of the underlying disease with the development of adverse outcomes.

Objective. The objective of our study was to compare the performance of vascular stiffness (VS) and the left ventricular (LV) remodeling process indicators in patients with arterial hypertension (AH) under renal replacement therapy (RRT), and patients with essential hypertension.Design and methods. 158 people were included in the study, divided into 4 comparable age groups: 32 patients receiving programmed hemodialysis (PH), 37 recipients of renal transplant (RT), 69 patients with essential AH and 20 healthy volunteers. All the patients underwent 24-hour blood pressure (BP) monitoring with an assessment of VS and central BP (SBPao) and echocardiography (EchoCG).Results. The patients under PH and after RT did not have any significant differences in the values of central and peripheral BP. Comparing the groups of patients under RRT with the group of essential AH, the office systolic (SBP) and diastolic (DBP) BP values did not differ significantly. Аlthough, at night, considerably higher DBP(n) and SBPao(n) values were detected in patients under RRT, and in the patients after RT SBP(n) and PP(n) values were also increased. An increase in the SBPao values of more than 10 m/sec was detected only in the groups of patients under RRT. In all the groups with hypertension all indicators of daily VS differed significantly from the group of healthy volunteers. PTIN (Pulse Time Index of Norm) in the studied groups had more evident differences: in the healthy volunteers it was in the range of 80-90%, in the patients with essential hypertension — 50-60%, and in the patients under PH and after RT — 20-40%. In all groups of patients with AH, the average the posterior wall thickness (PWT) of the LV and the interventricular septum thickness (IVST) were close to the upper limit of the norm. In the groups of patients with AH an increase in the relative wall thickness (RWT) of the LV was also detected. Furthermore, considerably higher the values of ILVmass, IVST were found in the group of patients on PH in comparison with the patients after RT. In addition, in all the groups of patients with AH, there was a tendency to LV spherification in comparison with the healthy volunteers, and in the group of essential AH the difference was more pronounced compared with the group under RRT.Conclusion. In the patients with arterial hypertension who undergo renal replacement therapy, higher average values of central BP, higher vascular stiffness (daily pulse wave velocity in the aorta and a longer period of pulse wave velocity increase in the aorta during the day (PTIN)) and less pronounced left ventricular spherification are recorded in comparison with the patients with essential hypertension while office BP values remained consistent.

The outcome of chronic kidney disease (CKD) is frequently development of end-stage kidney failure that requires program hemodialysis (PHD). Increase of the longevity of long-term PHD patients is associated with continuous somatic and psychic stress for the patient, which might adversely affect the quality of life (QoL) of an end-stage CKD patient.Purpose: to determine the influence of age and dialysis duration on the QoL of end-stage CKD patients receiving PHD.Materials and methods. 50 patients receiving PHD (23 men and 27 women), aged 31 to 79 years, were examined. The mean age was 56.72±11.26 years. The PHD duration ranged between 1 month to 20 years, the average figure being 5.26±4.82 years. The control group included 50 healthy subjects of comparable gender and age. The QoL evaluation data were gathered through survey using the Russian version of SF-36 Questionnaire (Short Form Medical Outcomes Study), validated by the Institute of Clinical and Pharmacological Studies (Saint Petersburg) and analysis of case records.Results. As regards the scales of physical health, a decrease of the QoL of PHD patients was found as follows: РF-physical functioning (54.1±25.6 vs. 85.0±21.4), RP-role functioning related to physical condition (38.5±35.4 vs. 74.5±29.7), Pbodily pain (64.7±32.1 vs. 70.5±24.8), GH-general health condition (51.3±15.9 vs. 65.1±21.7). A trend towards inter-group difference was also discovered as regards the scales of vitality (VT) (53.7±19.5 vs. 61.0±19.4), social functioning (SF) (72.5±18.0 vs. 79.5±23.5). Multiple regression analysis established inverse relationship between the patient’s physical health component (PH) and age (rs=-0.317, P

The clinical case is fairly rare combination of severe somatic pathology (neuroendocrine cancer, terminal chronic kidney disease, program hemodialysis, etc.) and orthopedic and traumatologic pathology (right femoral neck pseudarthrosis) requiring surgical intervention with high risks for patient’s life. The patient has been suffering from polyneuroendocrine cancer since 2001. The history of multiple surgical interventions for polyneuroendocrine cancer is presented. Neuroendocrine cancer is considered as the least often oncologic disease. It is very dangerous, because neuroendocrine cells are spread throughout the body and can affect almost any organ. The treatment prognosis is unknown. At present, this type of cancer is poorly researched, which precludes the introduction of new treatment options and preventive activities. In the setting of comorbid pathology that arose from neuroendocrine cancer treatment (comorbidity index 12, according to ASA IV), the patient received the right femoral neck fracture. Surgical treatment for femoral neck fracture in patients burdened with comorbid pathology is a challenge for surgeons, anesthesiologists-resuscitators, therapists, nutritiologists, and doctors of other specialties. An abandonment of surgical intervention worsens the quality of life, aggravates disability, leads to the development of trophic, thrombo-embolic and infectious complications, and increases the likelihood of adverse outcome. Surgical treatment in the setting of specialized hospital is the most expedient. Therefore, due to comorbidity of such patients, a niche-targeted approach to treatment by specialists is needed at all stages of treatment with a seamless transfer of care and consistency of treatment activities.

Aim. Determination of desialized apolipoprotein-B-100 (apoB-100) and lipoprotein-containing circulating immune complexes in patients with chronic kidney disease (CKD) in program hemodialysis with type 2 diabetes mellitus. Materials and methods. We examined 81 patients with CKD (50 men / 31 women) treated with program hemodialysis, of which 36 (17/19) with type 2 diabetes mellitus, 45 (33/12) non-diabetic patients. The levels of total cholesterol, triglycerides and desialylated apoB-100 in blood plasma and lipoprotein-containing circulating immune complexes. A color duplex scan of brachiocephalic arteries was used to assess the extent of development of atherosclerosis with the determination of the thickness of the intima-medial complex. Results and discussion. Patients with diabetes had high values of total cholesterol, triglycerides (p

Atrial fibrillation (AF) is one of the most common heart rhythm disorders. Its prevalence reaches 1% in the General population and exceeds 7% in people over 60 years of age. Among the total number of people hospitalized for arrhythmias, patients with AF make up about 40%, and the main reason for such hospitalizations is recurrent arrhythmias. The urgency of the problem the OP is dictated not only by the high frequency of associated thromboembolic complications and deterioration of patients' quality of life, but also a significant increase in the risk of total and cardiovascular mortality patients this urged us to conduct our research [ABSTRACT FROM AUTHOR]

Aim: The aim of the study was to investigate of the effectiveness of standard anti-anemic therapy for patients with anemia in the presence of chronic kidney disease treated with program hemodialysis. Material and research methods. 120 patients with CKD V and anemia receiving programmed hemodialysis were included into study. The inclusion criterion was a hemoglobin concentration below 10 g/dl. After the initial examination, all patients in a planned manner for an antianemic purpose took an oral iron 1 tablet per day once and EPS (recombinant erythropoietin beta) 50mU/kg intravenously with each hemodialysis procedure. Patients were examined for the presence and nature of anemia. In addition, serum iron, ferritin, and transferrin iron concentrations were estimated. Laboratory data obtained in a cohort of healthy volunteers within the 95% confidence interval were used as reference values. A month after inclusion in the study, all patients underwent a repeated hematological analysis, according to the results of which groups with achieved blood hemoglobin level of 12g/dl and higher (good hematological response) and below 12g/dl (insufficient hematological response) were isolated. Conclusion: in patients with CKD with anemia, it has a normochromic and normocytic character with signs of red blood cell anisocytosis. The use of an oral iron preparation and recombinant erythropoietin alpha within a month revealed two types of response - an increase in hemoglobin concentration to 12g/d l or more and failure to achieve the target concentration of heglobin (resistance to standard treatment for EPS), which was found in 72.5% of patients. The prognostic factor in the development of resistance to antianemic therapy is the duration of program hemodialysis (in the present study, 24 months or more). [ABSTRACT FROM AUTHOR]

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The calcium phosphoric metabolism was analyzed depending on the severity of renal functioning disorders. Chronic renal disease is known to be associated with impaired mineral metabolism in terms of hypocalcaemia, hyperphosphatemia and enhanced level of Ca × P product that aggravates in chronic renal failure progression. The majority of patients with nephropathy have parathyroid hormone concentration to be different from target one recommended by NKF-K/DOQI (2003), at that secondary hyperparathyroidism prevails on pre-dialysis stage of chronic renal disease, the relative hypoparathyroidism is common among the patients received dialysis.

Aim: Determination of desialized apolipoprotein-B-100 (apoB-100) and lipoprotein-containing circulating immune complexes in patients with chronic kidney disease (CKD) in program hemodialysis with type 2 diabetes mellitus., Materials and Methods: We examined 81 patients with CKD (50 men / 31 women) treated with program hemodialysis, of which 36 (17/19) with type 2 diabetes mellitus, 45 (33/12) non-diabetic patients. The levels of total cholesterol, triglycerides and desialylated apoB-100 in blood plasma and lipoprotein-containing circulating immune complexes. A color duplex scan of brachiocephalic arteries was used to assess the extent of development of atherosclerosis with the determination of the thickness of the intima-medial complex., Results: Patients with diabetes had high values of total cholesterol, triglycerides (p<0.05). Duplex scan of brachiocephalic arteries showed an increase in the thickness of intima-medial complex in all patients for program hemodialysis, however, in patients with diabetes, the thickness was 13% higher (p<0.05). In patients with diabetes, plaques with stenosis up to 50% prevail, compared with non-diabetic patients, p<0.05. The incidence was significantly higher for desialized apoB-100 by 46% in patients with diabetes on hemodialysis compared non-diabetic patients (p<0.05). An increase in the level of lipoprotein-containing circulating immune complexes by 39%, (p<0.05) in patients with diabetes mellitus was observed, compared with patients non-diabetic patients. The correlation between desialized apoB-100 and duplex scan of brachiocephalic arteries parameters (r=0.325), as well as between the cholesterol level and stenosis up to 50% (r=0.465) in patients with diabetes mellitus, was found to be of medium strength. The patients with diabetes and CKD, myocardial infarction developed 79% more often than in patients without diabetes (p<0.05). Thus, immunogenic lipid markers of atherosclerosis can be considered both as mechanical factors of atherogenesis and diagnostic and prognostic characteristics in type 2 diabetic patients with impaired renal function and chronic renal insufficiency., Conclusion: Accelerated development of atherosclerosis with diabetes and CKD, confirmed with the help of duplex scan of brachiocephalic arteries, may be associated with an increase in the level of modified low density lipoprotein.