Vol 11, No 3 (2019)

Background. The modern concept of the adequacy of dialysis from the perspective of a doctor implies primarily the adequacy of the removal of toxins, water balance and nutrition. In recent years, however, the outcome of treatment from the position of the patient, in particular the tolerability of the dialysis procedure itself, has been increasingly important. In this regard, new instrumental methods for monitoring the achievement of the dialysis dose and the prevention of complications of the dialysis procedure, which allow to find a balance between the achievement of treatment targets and the satisfactory tolerance of the hemodialysis (HD) procedure are of great interest. objective. to evaluate the possibilities of new instrumental options - on-line-measurements of the provided dialysis dose using ultraviolet spectrophotometry of the spent dialysate in achieving an adequate dose of the dialysis session and the computer algorithm for ultrafiltration (UF) rate control for the prevention of intradialytic hypotension. Material and methods. The work included data from a single-center study enrolling of 135 patients with an established diagnosis of chronic kidney disease-5D at the B. Brown Avitum dialysis center in Moscow. In order to solve the tasks set in the work, two clinical trials were conducted; the first included 100 patients and evaluated the comparative effectiveness of various methods of measuring the provided hemodialysis dose over a calendar year. the ekt/v index data was recorded using the adimea on-line dialysis dose monitoring unit and calculated on the basis of laboratory blood samples before and after the HD procedure using the second generation daugirdas’ formula as the reference method. the second study included 35 patients with a tendency to intradialytic hypotension (IDH) and evaluated the feasibility of a new method for uf rate control using the module of an automatic blood pressure control (ABPC) system to prevent symptomatic episodes of idh. results. the mean uv-ekt/v values obtained by the ultraviolet spectrophotometry of spent dialysate did not significantly differ from the ekt/v calculated by the Daugirdas’ formula using the reference method of laboratory samples (1.65±0.26 and 1.64±0.24; p=0.93), while a strong correlation between the results obtained by both methods (r=0.8, p=0.000) was consistently revealed. The advantages of the method of on-line monitoring of spent dialysate include the elimination of errors when taking blood samples by medical personnel, the lower variability of the ekt/v index, and the ability to timely detect a decrease in the dialysis dose, establish its causes and make adjustments to the hemodialysis program. Using a new approach to the prevention and correction of idh with a computer-based uv rate control algorithm, reliable data were obtained - the average values of pre- and post-dialysis systolic blood pressure (SBP) and diastolic blood pressure (DBP) were higher when using the abpc module. the pre-dialysis sbp and dbp levels were 132.б±25 and 78.6±18.1 versus 124.3±26.6 and 73.7±18.1 mm hg (p=0.009 and p=0.0008, respectively). the postdialysis blood pressure levels differed: when using abpc module, the average blood pressure levels were higher than with the standard approach. the postdialysis sbp and dbp levels were 12Б.7±24 and 7Б.9±18.3 versus 114.3±24.4 and 71.2±16.э mm hg (p=0.002 and p=0.006, respectively). when using abpc system, the intradialytic blood pressure variations were higher: sbp 124.0±20.5 VERSUS 110.2±17.3 (P=0.03) AND DBP 75.9±14.2 VERSUS 68.3±17.9 mm hg (p=0.02) thus, the use of a uf control system led to an increase in intradialysis sbp by 11.1%, dbp by 10%, and map by 9.83%. the number of interventions of a 40% glucose solution (10.0) decreased by 54.5% - from 86 to 27 (p=0,000). the results of our study showed that the prevalence of hypotension episodes when applying the conservative approach without computer uf rate control was 26.2% (211 cases per 1134 blood pressure measurements), while when using the abpc module, the frequency of hypotension significantly decreased and was 8.3% (387 cases per 4972 blood pressure measurements). the percentage reduction was 20.33% (p=0,000). thus, the obtained results allow to conclude that instrumental method for uf rate control is effective in the prevention of symptomatic idh episodes associated with high uf rates. Conclusion. On-line monitoring of the dialysis dose is the preferred method for estimating the ekt/v index due to a number of advantages compared to the classical method for evaluating laboratory blood samples: it eliminates errors during blood sampling by personnel, monitoring of the ekt/v index lasts throughout procedure, the dialysis dose is determined at each hemodialysis session, which allows timely adjustments to the dialysis program. The use of a computer algorithm for uf rate control contributes to the optimization and personification of the hemodialysis program, making it possible to reduce the number of idh episodes and reduce the frequency of interventions during the procedure. continuous monitoring of the patient’s controlled parameters during the hd procedure and the “feedback” option reduces the risk of complications and improves the quality of treatment as a whole.

Objective. evaluation of the immediate clinical results of endovascular correction of renal artery stenosis (ECRAS). material and methods. the immediate results of ecras were analyzed in 121 patients who underwent 147 interventions. all patients had arterial hypertension (ah), which was diagnosed in accordance with who recommendations (1999), and chronic kidney disease (CKD). ckd stage was assessed by glomerular filtration rate using the ckd-epi formula. a period of зо days was chosen as the immediate postoperative period. the results of ecras were evaluated at з and зо days after the intervention. efficiency of stent functioning or renal artery patency after angioplasty was analyzed, and serum creatinine (Cr) and blood pressure (bp) levels were compared before and after ecras. assessment of the functional state (patency) of the stent after the intervention was carried out by ultrasound dopplerography. results. з and зо days after the intervention, deaths and postoperative complications were not recorded. all ecras procedures were effective. the average cr level in the study group significantly decreased by 7.48 mmol/l after з days and by 10.84 mmol/l зо days after ecras (Wilcoxon test; p<0.001), as well as by з.08 mmol/l after зо days compared with the result on day з after ecras (Wilcoxon test; p<0.001). blood pressure level statistically significantly decreased after ecras (Wilcoxon test; p<0.001; sign test; p<0.001). conclusion. ecras is a safe intervention for the life of patients in the immediate postoperative period. the ecras method is highly effective in restoring and maintaining renal artery patency. the clinical efficacy of ecras consists both in maintaining and improving renal function, and in correcting the severity of hypertension.

Background. Assessment of the prevalence of chronic kidney disease (ckd) in the population is critical for planning and preventing kidney disease for the medical community and government. objective. this study estimated the prevalence of ckd among the adult population of Moscow. material and methods. ckd stages i-5 were determined by the method of calculating glomerular filtration rate (GFR) using the ckd-epi equation. results. we found that patients with stage i-5 ckd accounted for 4% of the total population, of which 4.8% were patients with stages 4-5, but this prevalence is less than in most other countries. Conclusion. This study showed a high prevalence of ckd among the population of Moscow, although it was limited by the lack of accounting for changes in urinalysis. at the same time, the analysis of the prevalence of ckd by stages showed a high proportion of the early stages of ckd with significantly lower detection rates of late stages. the latter fact, most likely, suggests that the mass of patients with ckd do not survive to the late stages of this pathology.

This review analyzes the prevalence, clinical features and prognosis of a secondary metabolic syndrome, including iatrogenic forms. secondary metabolic syndrome is a frequent complication of chronic alcohol intoxication, hepatitis c virus infection, the use of oral hormonal contraceptives, treatment with glucocorticosteroids, antiretroviral drugs, regular hemodialysis, permanent peritoneal dialysis, and transplantation.

The conservative treatment of ureteral stones remains one of the problems in the treatment of urolithiasis. despite the development and improvement of medical instruments and methods for surgical removal of stones, the use of conservative effect aimed at ensuring the spontaneous passage of stones and their fragments from the upper urinary tract (UUT) has not lost its significance. The desire to accelerate the process of stone discharge led to the widespread occurrence of a variety of physiotherapeutic procedures. with the accumulation of knowledge about the molecular biochemical characteristics of the physiology of smooth muscle cells of the ureter and the development of pharmacological science, there is growing interest in the possibility of targeted use of medications, the effect of which could significantly accelerate the process of spontaneous stone discharge.