Vol 14, No 1 (2022)

Background. COVID-19 in solid organ transplant recipients is usually characterized by more severe disease course and is often associated with life-threatening complications. Identification of additional factors that may affect the risk and severity of the new coronavirus infection could have a significant impact on choosing a management strategy for renal graft recipients. Aim. To evaluate the possibility of cross-immunity between skin manifestations of viral etiology and COVID-19. Material and methods: From May 2020 to February 2021 we examined 180 renal graft recipients with a history of transplantation from 2 months to 26.5 years. All patients were categorized into two groups: group I, those who had confirmed moderate or severe COVID-19 disease and group II, and those without any history of clinical manifestations of the new coronavirus infection (including those with potentially asymptomatic disease). During the study period which lasted for 71 months on average (range, 2 to 318 months), laboratory workup was performed in all patients (on average, twice): dermatological examination and detection of serum antibodies to herpes simplex virus 1, 2, cytomegalovirus, Epstein-Barr virus, SARS-CoV-2. Results: In recipients with HPV-associated skin manifestations, the incidence of COVID-19 was significantly lower than in recipients who did not have them - 30.4 and 50.0%, respectively (p=0.011). The incidence of new coronavirus infection did not differ in the groups of patients with cutaneous manifestations caused by herpes simplex viruses type 1 and 2, and without them. Among recipients with Epstein-Barr virus seropositivity, there were significantly fewer cases of COVID-19 compared to seronegative patients - 26.2 and 54.8%, respectively (p=0.0002). Conclusion: HPV-associated dermal manifestations of serum EBV-seropositivity in renal graft recipients is associated with lower incidence of moderate and severe COVID-19. Further studies are needed to confirm the possibility of cross-immunity against SARS-Cov-2 with other infections

Objective. Assessment of the functional state of the kidneys and the albuminuria level in individuals with cardiovascular risk factors. Material and methods: The cross-sectional study included 70 outpatients with cardiovascular risk factors, mean age 66 (60; 72) years. Traditional risk factors and the presence of concomitant diseases were assessed. The calculation of the glomerular filtration rate was carried out according to the CKD-EPI formula, the albuminuria level was determined by the urine albumin/ creatinine ratio. Results: It was revealed that 20 (29%) of the examined patients had signs of CKD C3, 33 (47%) had albuminuria level A2 and higher. In the surveyed population, eGFR was associated with age (r=-0.51, P<0.05), and the level of albuminuria - with TG (r=0.31, P<0.05). In patients with abdominal obesity, the albuminuria level was statistically significantly higher, and eGFR did not depend on the presence of abdominal obesity. Conclusion: In patients with abdominal obesity, the albuminuria level, rather than eGFR, is an important prognostic marker.

The relevance of research in the development of methods for non-invasive laboratory diagnostics of chronic kidney disease and concomitant chronic renal failure is due to the high frequency of their occurrence, long-term asymptomatic course of the disease and the high cost of treatment for this category of patients: the cost of their treatment makes up a significant part of the national health budgets of developed countries with a comparatively small proportion of these patients from the total number of all patients. The aim of this work was to assess the capabilities of saliva spectroscopy by the method of monochrome analysis of nanoparticles to study the characteristic features of its subfractional composition in patients with chronic kidney disease with the development of chronic renal failure. to do this, it is necessary to solve a number of problems: to develop a diagnostic algorithm for monochrome analysis of nanoparticles to determine the severity and pathophysiological orientation of homeostatic changes in patients with various forms of chronic kidney disease using samples from oropharyngeal swabs. material and methods. studies were carried out at the center for European and oriental medicine from 2019 to 2021 (39 patients with verified diagnoses of chronic kidney disease were examined), during which it was found that the most typical saliva spectra of these patients were characterized by a multimodal distribution of nanoparticles saliva in size and contribution to light scattering on large particles larger than iooo nm, which was statistically significant (p <0.001) when conducting a comparative analysis with saliva spectra of practically healthy individuals and patients with general somatic inflammatory kidney diseases without the development of chronic renal failure. the indicator of the diagnostic sensitivity of the method in relation to chronic kidney disease with chronic renal failure was 92%. Conclusions. the use of laser spectroscopy of saliva is scientifically substantiated for the non-invasive detection of chronic kidney diseases with the development of chronic renal failure, when, with a timely diagnosis, therapeutic measures will be most effective.

Background. Protein-energy wasting (PEW) is widespread condition among patients receiving maintenance hemodialysis (MH). A serious destabilizing factor in nutritional status is insulin resistance and chronic inflammation, which are especially pronounced in the presence of diabetes mellitus in addition to chronic kidney disease. Given that type 2 diabetes mellitus (T2DM) has become one of the leading causes of end-stage chronic kidney disease (ESRD), it is especially important to develop an effective strategy to resist the progression of protein depletion and ensure better survival and quality of life in such patients. We believe that identifying inadequate intake of essential nutrients and calories, dietary counseling and diet correction can make a noticeable beneficial effect on nutritional status and the degree of chronic inflammation in patients with PEW, including those with T2DM. The aim of the study. To assess the efficacy of diet therapy in the correction of metabolic disorders based on a comprehensive assessment of the nutritional status and dynamics of chronic inflammation biomarkers in patients with CKD and T2DM on MH. Material and methods. The study involved 79 patients (mean age 62.0±11 years), with an average duration of MH 10.0±5.4 years. Patients were divided into 2 groups: with T2DM (T2DM+, n=40) and without T2DM (T2DM-, n=39). In both groups, an analysis of the nutritional status of patients was carried out (using physical, laboratory and instrumental parameters), the data of protein, fat and carbohydrates dietary intake were collected and analyzed on the basis of food diaries. All patients were prescribed an individual corrective diet in order to bring the parameters of the diet to those recommended for patients on MH, in the T2DM group - taking into account the compensation of hyperglycemia. Soy isolate was used as an additional source of complete protein. The dynamics of changes in indicators of nutritional status and chronic inflammation from baseline in both groups was monitored after 6 and 12 weeks of diet therapy. A comparative analysis of the dynamics of indicators between the groups was carried out. Results. PEW was 2 times more frequent in the group with T2DM - 26 (65%) patients; in the group without T2DM, PEW was diagnosed only in 11 (28%) patients. The initial bioimpedance data obtained indicated a more frequent presence in patients with T2DM of "sarcopenic obesity": reduced lean mass in the presence of increased body fat and increased waist circumference. The severity of chronic inflammation, according to the corresponding biomarkers (interleukines 1 and 6, advanced glycation endproducts, C-reactive protein) was also higher in the T2DM+ group. The diet of diabetic patients was poorer in all macronutrients and significantly lower in energy supply. After correcting the composition of the diet for macronutrients and calories, positive changes in some of the objective indicators of nutritional status and biomarkers of chronic inflammation were noted in both groups by the end of the study (12 weeks). These changes were more evident in the T2DM+ group. Conclusion. The presence of T2DM in patients with CKD on MH significantly aggravates the disturbances in nutritional status and increases the degree of chronic inflammation in comparison with patients without T2DM. Conducted adequate dietary therapy based on the obtained indicators of nutritional status and food diaries can reduce the degree of chronic inflammation and PEW in this category of patients.

Secondary hyperparathyroidism (SHPT), commonly encountered in patients receiving maintenance dialysis, is associated with numerous adverse outcomes, including vascular and valvular calcifications, changes in bone metabolism and an increased risk of cardiovascular morbidity and mortality. Calcimimetics, agents that act on the calcium sensing receptor (CaSR), were designed to overcome limitations in the use of vitamin d sterols to treat shpt, and have demonstrated efficacy in reducing levels of PTH in randomized trials. Currently available calcimimetics include oral cinacalcet (CC) and the recently approved intravenously administered agent, etelcalcetide (EC). while CC is an allosteric modulator of the casr, EC acts as a direct CaSR agonist. Etelcalcetide’s properties allow it to be administered intravenously thrice weekly at the end of a hemodialysis treatment session, which undoubtedly increases adherence to therapy and reduces the burden of using tablet preparations. In randomized clinical trials, EC has been shown to be more effective than CC in reducing levels of PTH, phosphate, calcium, fibroblast growth factor 23 (FGF23). This review compares and contrasts the pharmacologic characteristics of CC and EC, discusses the results of clinical trials involving these drugs, and posits implications for their use for clinical practice.

With uremia, it becomes necessary to reduce the nitrogen level in the diet while maintaining the satisfaction of the human body's need for essential amino acids. In this regard, the latter are replaced in the diet with the corresponding α-keto acids or α-hydroxy acids that are in equilibrium with them, in the expectation that keto acids will turn into amino acids during transamination. However, some essential amino acids are not replaced by the corresponding α-keto and hydroxy acids and are administered unchanged. The article discusses the possibility of replacing 10 essential amino acids with α-keto- and hydroxy analogues in the diet of uremic patients, of which 2 are nonessential for healthy people. The substitution base of each amino acid by its analogue is analyzed. Recommendations on providing patients with threonine and methionine are given. Since nephropathies can be of diabetic origin, each amino acid is also analyzed for glucogenic or ketogenic effects. The presence of the latter is recognized as the basis for limiting the introduction of this amino acid and its α-keto or hydroxy analogue