No 1 (2015)

Purpose. To determine the incidence of acute kidney injury (AKI) and its prognostic value for patients with metabolic syndrome (Ms) and intact glomerular filtration undergoing coronary artery bypass grafting (CABG). Material and methods. a total of 782 patients (5і4 men and 268 women) aged 54 to 67 years (mean age - 62.3 ± 4.6 years), who routinely underwent CABG with EXTRACORPOREAL circulation, were evaluated. Of these, 513 (65.6%) patients had no diagnostic criteria for ms (Group і), while 269 (34.4%) patients were diagnosed with ms (Group 2). For all patients, the initial value of the glomerular filtration rate (GFR) was greater than бо mL/min/1.73 m 2, as defined by EPI-CKD creatinine equation. Results. In Group i, postoperative AKI occurred in і23 (24.0%) patients, in the Group 2 - in 94 patients (34.9%). As a result, both groups were divided in two subgroups - those with and without AKI. In Group 1, stage 1 AKI and transient AKI were significantly more frequently detected, and in the Group 2 - stage iii AKI and persistent AKI. In both groups, the development of AKI was associated with a high rate of early cardiovascular events after CaBG, and intergroup difference were revealed, especially in patients who did not have AKI. It is shown that the majority of parameters of ms were significantly higher in the Group 2 than in the Group I regardless the presence of the AKI. In-hospital mortality in both groups of patients with AKI was significantly higher than in patients without the AKI. Conclusion. It is revealed that the presence of ms in patients undergoing coronary artery bypass grafting is associated with a high incidence of AKI and poor prognosis in immediate postoperative period.

Purpose. The aim of this study was to evaluate the dynamics of pulmonary artery pressure within a year of hemodialysis treatment and investigate the relationship between blood flow in arteriovenous fistula and pulmonary artery pressure. Material and methods. 50 dialysis patients (і9 males and 31 females) were evaluated. at the beginning of dialysis 42 patients had arterial hypertension and 32 patients - chronic heart failure. At the beginning of dialysis and after a year follow up in all patients cardiac functions were evaluated by echocardiography and arteriovenous fistula flow (AVF) was measured by Doppler sonography. Pulmonary hypertension was diagnosed according to criteria of Guidelines for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology. Results. Pulmonary hypertension was found in 29 (58%) patients. Before the beginning of dialysis correlation was detected between systolic pap and LVMMI (R=0.56; P=0.008), left ventricular ejection fraction (R=-0.54; P<0.001), hemoglobin (R = -0.37; P = 0.01) and LV IisovolumicC relaxation time (IVRT: R = 0.79; P<0.001). At the end of the follow-up left ventricular myocardial mass decreased FR0M159.1±35.8 to 129.1±42.2 g/ m 2 (Р = 0.04), systolic pap decreased from 46.3±16.1 to 40.4±11.7 MM Hg (Р=0.01). No correlation was found between PAP and arteriovenous fistula flow (R = 0.11; P=0.3). Conclusion. Pulmonary hypertension was observed in half of the patients at the beginning of HD and was associated with left ventricular hypertrophy, systolic and diastolic left ventricular dysfunction. a year later a partial regression of LVH and decrease the severity of pulmonary hypertension were found. There was no correlation between arteriovenous fistula flow and pulmonary artery pressure.

Objectives. To optimize drug therapy in patients with arterial hypertension and tubulointersticial disease. Material and methods. a total of З45 patients were screened of whom 55 were enrolled in the study. The patients were comparable regarding major baseline characteristics. Dietary salt intake was limited to < 6 g/day. After ЗО days of the study 13 patients were excluded due to blood pressure normalization and being not required antihypertensive treatment. The patients were randomized into two treatment groups («a» and «t»): azilsartan and torasemide Sr, respectively. In all patients at the beginning of drug therapy and at the final visit ABPM was performed, conductivity of the urine and natriuretic activity were assessed. Data management and analysis were performed using Statistica і0.0. Results. In the group «a» 58.3% of the patients had «non-dipper» bp profile at the DO visit vs. і8.75% at the final visit, «dipper» 46.6% vs. 81.25%, «night-peaker» ЗЗ.З% vs. 0.0%. In the group «t» bp profile «non-dipper» at the DO visit had 41.6% of patients vs. 11.76% at the final visit, «dipper»53.3% vs. 82.35%, «night-peaker» 66.7%VS 5.88%. At the DO visit «evening conductivity» in group «a» was 40.7 ± 17.7 ms /cm and 4З.5 ± 19.З 7 ms /cm in the group «t» (p> 0.05), «evening natriuresis» was ЗО5.12 ± 1ЗО.9 mmol/l in the group «a» and 317.5 ± 1З9.2 in the group «T»(p> 0.05). At the visit D4 «evening conductivity» was 26.З ± 10.З ms /cm and 28.9 ± 15.5 - in the group «a» and «t» (p = 0.58), respectively, «the evening natriuresis» was 203.8 ± 86.76 mg/dL in the group «a» and 205.і ± 1 і5.7 mg/dL in the group «t» (p = 0.97). At the DO visit augmentation index (Ai) in the aorta in the group «a» was 7.5 [31.0; -6.0] and 17.0% [-5.0; 36.0]% IN THE GROUP «T»(P = 0.69). ΙΑ at THE visit D4 IN THE aorta IN THE group «a» amounted TO -13.5 [-21.0; -2.0] % and TO -1.0 [-9.0; 9.0]% IN THE group «T»(p = 0.03). Conclusion. Conductivity of the urine and natriuresis, measured in the evening hours, reflect the renal RTT function and can serve as markers of unfavorable blood pressure profile. For patients with a low salt intake (less than 15 g /d) azilsartan is more effective due to producing greater ΙΑ changes than torasemide Sr (2 [-9.5; 15.5]%) in THE aorta (-21 [-29.9; -16]%), affecting the activity of the Raas. Torasemide Sr, increasing sodium excretion, showed the best result in patients with high salt intake (more than 15 g /day) (ΙΑ aorta was -9 [-14; -2]%), P = O.OOO2.

Urate stones account for 5-10% of all urinary calculi. The key point in stone formation is the adhesion of the microcrystals of uric acid in the tubular urine to the apical nephrothelial membrane. Urate nephrolithiasis may develop against the background of normal excretion of uric acid in the urine in conditions of reduced ammoniogenesis, leading to a decrease of urinary pH. Nutrition can have a significant impact on the purine metabolism and urine acidity, especially in patients with gout, and is one of the key components of the management of patients with hyperuricemia, but to a lesser extent, affects the risk of uric acid stone formation. In fact, citrate mixture is buffer component causing urinary alkalization by hydrolysis with formation of strong base ions and a weak acid. Blemaren has certain advantages over other citrate mixtures, which include predominance of citric acid over citric salt, as well as significant proportion of potassium hydrogen carbonate as buffer component. Thus, hyperuricosuria and decrease of pH due to lower ammoniogenesis are the main pathogenetic factors for uric acid stone formation. The use of citrate mixtures, especially Blemaren, can effectively control the urate urolithiasis, leading to litholysis and reducing the risk of stone recurrence.

Recent studies of biomarkers in a population of patients with atrial fibrillation showed that their use may improve risk stratification. It has been shown that cardiac biomarkers such as troponins and natriuretic peptides, in combination with available clinical risk stratification models allow to better anticipate the possibility of complications. Similar data are available regarding biomarkers of kidney function and coagulation.