No 3 (2017)

Aim. to evaluate the prognostic value of kidney damage in patients with ST-segment elevation acute myocardial infarction (STEMI) in a prospective 6-month observational study. Material and Methods. a prospective 6-month observational study included 241 patients with STEMI. The kidney function was evaluated by calculating the creatinine clearance using the CKD-EPI formula. An evaluation of the effect of renal dysfunction on cad outcomes for 6 months was carried out. The endpoints of the study included: hospital mortality, cardiovascular mortality during follow-up, readmissions for acute coronary syndrome (Acs). Results. 41.1% of patients had renal dysfunction (GFR <60 mL/min). Hospital mortality was rec-orded in 9.5% of cases; the highest mortality rate was recorded in the group of patients with GFR <60 ml/min - 17.2%, while among patients with GFR> 60 ml/min - 4.2% (p=0.001). Hospital mor-tality with GFR from 45 to 59 ml/min was 6.3%, GFR from 30 to 44 ml/min - 42.9%, GFR from 15 to 29 ml/min - 60.0% (p<0.001). GFR <60 ml/min increases the risk of the combined primary end-point by 3 times (RR 95% 2.917 (1.360-6.254, p=0.006), GFR from 45 to 30 ml/min - by 8 times (RR 95% 7.714 (2,076-28,661, P=0,002), and GFR from 30 to 15 ml/min - by 10 times (RR 95% 10,286 (2,383-44,398, P=0,002). Conclusions. In patients with STEMI, a decrease in GFR is an unfavorable predictor of fatal out-come within 6 months of follow-up.

Aim. To evaluate the effect of pre- and postdialysis hypertension, normo- and hypotension, as well as intradialysis changes in blood pressure (BP) on the survival of patients receiving program hemodialysis (HD). Material and methods. The study included 3723 patients who were on program hemodialysis at the dialysis centers of the B. Brown Avitum Russland network, and who started hemodialysis treatment from 2011 to 2016. BP was recorded before and after the dialysis procedure, and at least every hour during the dialysis procedure. The parameters of the averaged blood pressure over the follow-up period were analyzed. Results. The averaged mean pre-dialysis blood pressure was 140±15.8 and 84±9.8 mm Hg, postdialysis -134.9±15.2 and 82.4±15.2. Three-year active survival rate of patients from the moment of inclusion in the study was 86%, a five-year survival rate - 78%. According to the Kaplan-Meier statistical model, survival depended on the values of pre- and post-dialysis blood pressure. Before the dialisis session, the subgroup of the upper quartile of systolic blood pressure (SBP, P <0.0001), and the subgroup of the lower quartile of diastolic blood pressure (DBP, p=0.001) showed the worst survival rate with high statistical reliability. Evaluation of the relationship between blood pressure and survival in the Cox regression model showed a significant effect of low predialysis DBP; the lowest survival rate after the dialysis session was observed in patients with a decrease in SBP <126 mm Hg. Evaluation of intra-dialysis variations in blood pressure revealed statistical significancant intensive decrease in SBP during the hemodialysis procedure by more than 20 and 30 mm Hg. It was found that high ultrafiltration (UF) rates lead to a significant decrease in SBP after a dialysis session. There was also a weak but significant inverse correlation between the UV rates and the change in SBP during the procedure. Conclusion. Low predialysis DBP levels and elevated SBP, as well as a decrease in SBP after dialysis procedure below optimal values have a significant effect on the survival of patients with CKD-5D. The effect of changes in blood pressure during the dialysis session on survival was established: an intra-dialysis increase in SBP by more than 10 mm Hg and a fall in SBP by 20 mm Hg and below statistically significantly worsen the prognosis of patients on the program hemodialysis. Association of high ultrafiltration rates with fall of blood pressure at the end of the HD procedure was demonstrated.

Aim. To evaluate the diastolic function of the heart in various variants of GPs. Materials and Methods. 55 patients aged from 17 to 58 (mean age, 32.76±10.3) years with GPs were examined (32 men, 23 women). All patients underwent nephrobiopsy. IgA, IgG and IgM GPs were diagnosed. Results. In the majority of patients (78.1%), the onset of the disease was diagnosed at a young age over 17 years. Clinically, most often there was a nephrotic syndrome (65.4%), and in most cases - in men (72.2%). Systolic and diastolic blood pressure was 130.3±20.0 mm Hg and 83.2±13.06 mm Hg, respectively. According to the nature of the immune deposits in different morphological types of GPs, we divided them into three subgroups. Analysis of clinical data has revealed statistically significant differences between patient groups. Diastolic dysfunction (DD) was diagnosed in 36.4% of patients with Gps at the early stages of the disease, before the development of renal failure. Conclusion. Each third patient with GP in the onset of the disease without renal failure was diagnosed with left ventricular dysfunction. The most pronounced signs of violations of diastolic LV filling were detected in patients with IgM nephropathy, as evidenced by reliable intergroup differences.

Improvement of methods for diagnosis and prediction of acute kidney injury is associated with the identification and evaluation of new biomarkers associated with early stage acute kidney injury and independent of the filtration renal function. The article presents data on the evaluation of the role of neutrophil gelatinase-associated lipocalin in the diagnosis of acute kidney injury. The results of a number of studies that demonstrate the reliable efficacy of NGAL as a biomarker for predicting the risk of developing acute kidney injury and renal tubular damage are analyzed. Detection of NGAL in the urine and blood can reflect the active damage of the renal tubules, predict a decrease in the glomerular filtration rate and, thereby, predetermine the progression of the disease. It has been established that blood and urine NGAL levels is a prognostically significant biomarker of the course of acute kidney damage of different etiology in both children and adults.

The second part of the review presents the methods of treatment of acute and chronic hyperkalemia in patients with impaired renal function (including diet therapy), particular attention is paid to the pathogenetic validity of the use of certain therapeutic measures.