Vol 15, No 1 (2023)

Background. The number of kidney transplants and the number of recipients living with a kidney transplant continues to grow; approaches to the management of recipients in the late period after transplantation are changing. This requires a modern assessment of trends in post-transplant mortality.

Objective. Comparative assessment of the data on mortality in kidney transplant recipients (KTRs) received at the City Clinical Hospital № 52 of the Moscow Healthcare Department from 2016 to 2020 with a systematic analysis of published studies on this issue.

Material and methods. The electronic MEDLINE, Scopus and the Cochrane Central Register of Controlled Trials databases were searched for eligible studies. All prospective and retrospective mortality studies with ≥ 50 KTR patients were considered eligible. A meta-analysis of proportions was performed using the Freeman-Tukey transform to calculate the weighted summary proportion under the fixed and random effects model. Of the total number of 187 studies found, 7 were included in the systematic review and meta-analysis, incl. and ours, with a total of 13,200 KTRs.

Results. In the analysis of 5-year survival, the proportion of deaths averaged 11.2% (fixed model) and 11.07% (random model). The mortality rate recorded in the Russian registry of the CCH № 52 of the Moscow Healthcare Department was lower (5.88%), however, in general, the meta-analysis data were not heterogeneous. The proportion of cardiovascular deaths in the studies analyzed was 0.87–3.3%, averaging 1.68% (fixed model), 1.91% (random model). The data were slightly heterogeneous. A greater variation was reported for the analysis of the incidence of death from sepsis or other infectious complications (0.8–6.0%), averaging 2.58% (fixed model) or 3.42% (random model). The scatter of data on the frequency of deaths from infectious complications was more heterogeneous, however, selection bias was detected in none of the cases.

Conclusion. This meta-analysis suggests that mortality in 2016–2020 among KTRs who lived for more than a year after kidney allotransplantation and were followed-up at the Moscow City Nephrological Center CCH № 52 of the Moscow Healthcare Department low than in the population of the same patients for the same period of time followed-up abroad. Given the limited number of enrolled patients and follow-up period, more research among KTRs is required.

Background. Chronic kidney disease (CKD) is a risk factor for severe and fatal novel coronavirus infection. The interleukin-6 (IL-6) receptor inhibitor levilimab improves the prognosis of COVID-19 by stopping the hyperimmune response.

Objective. Evaluation of the efficacy and safety of levilimab in the treatment of COVID-19 in patients with chronic kidney disease.

Material and methods. A retrospective analysis of the data of 56 patients with CKD (in the majority - stages 3A–4) with the median serum creatinine level 173 (137; 237) µmol/l, who received levilimab for moderate and severe COVID-19, was carried out. Levilimab was prescribed at a dose of 162 to 648 mg, mainly intravenously on the first day of hospitalization.

Results. During therapy with levilimab, there was a rapid relief of symptoms of hyperinflammation and a decrease in the need for oxygen therapy. There was no deterioration in renal function in any patient. On the contrary, in 75% the creatinine level decreased, median level at the time of discharge was 127 (106; 185) µmol/l, which was accompanied by an increase in the median glomerular filtration rate from 27.5 at admission to 41 ml/min/1.73 m² at discharge (P<0.0001). In the period from the 4th to the 18th day of hospitalization, 94.6% of patients were discharged with recovery, which was accompanied by an improvement in kidney function in 79% of cases. A lethal outcome was observed in 3 (5.4%) patients who were admitted to the intensive care unit in an extremely serious condition and had severe concomitant pathology. No serious side effects were observed during treatment with levilimab.

Conclusion. In patients with CKD, levilimab has a good safety profile and is quite effective as a pathogenetic therapy for COVID-19, regardless of the degree of renal dysfunction.

Objective. Evaluation of the participation of fibroblast growth factor 23 (FGF-23) in relation to mineral metabolism indicators in the development of acute myocardial infarction (AMI) in patients with chronic kidney disease (CKD) receiving renal replacement therapy; assessment of the risk of fatal and non-fatal cases .

Material and methods. A prospective cohort study of 85 patients with stage 5D CKD on program hemodialysis was conducted over a period of 3 years. At the first stage of the study, indicators characterizing mineral and bone disorders such as blood phosphate, calcium, parathyroid hormone (PTH), calcitriol (1,25(OH)D), fibroblast growth factor 23 (FGF-23) and transmembrane protein Alpha- Clotho (A-Klotho) levels were determined. The second stage of the study was carried out 3.1±0.1 years after with the registration of cases of fatal and non-fatal AMI.

Results. 10 cases of AMI were registered: 6 non-fatal and 4 fatal cases. It was found that high FGF-23 and low A-Klotho levels do not have independent risk activity against AMI (P>0.05). Analysis of the combined effect of high FGF-23 and/or low A-Klotho levels with hyperphosphatemia and 1,25(OH)D3 deficiency demonstrates a significantly significant increase in the risk of developing all cases of AMI (P<0.05); a relationship with 1,25(OH)D3 deficiency in cases of fatal and non-fatal AMI (P<0.05) was shown. A statistically significant effect of an isolated 1,25(OH)D3 deficiency, a concomitant effect of several factors (hyperphosphatemia, hyperparathyroidism, vitamin D deficiency) on the risk of AMI was established.

Conclusion. FGF-23 is one of the key markers for the development of both fatal and non-fatal cases of AMI, predicting cardiovascular risk in CKD patients. Data on the concomitant influence of several factors among mineral-bone disorders on the risk of AMI are noteworthy.

Objective. Evaluation of the indicators of mineral and bone disorders, as well as central aortic pressure (CAP) at the pre-dialysis stages of chronic kidney disease (CKD).

Material and methods. The study included 108 middle-aged patients with CKD (53.6±14.9 years), 66 (61.1%) men and 42 (38.9%) women. All patients with CKD underwent general clinical and biochemical examinations to determine the parameters of mineral metabolism - calcium, phosphorus, parathyroid hormone (PTH), vitamin D, alkaline phosphatase levels. The CAD levels and lipid metabolism were assessed. Estimated glomerular filtration rate (eGFR) was determined by the CKD-EPI method based on serum creatinine level. The total sample was divided into two groups: group 1 - CKD with GFR>60 ml/min/1.73 m2 (n=33); group 2 - patients CKD with GFR ≤60 ml/min/1.73 m2 (n=75), and the patients of both groups were comparable in age.

Results. In the group of patients with CKD and eGFR≤60 ml/min/1.73 m2 (n=75), the following changes were recorded: arterial hypertension and stable angina were detected significantly more often (P<0.05); the systolic and diastolic blood pressure (BP) and CAP levels were significantly higher, and the of hemoglobin (Hb) concentration and the peripheral red blood cell count were significantly lower (p<0.05). A significant decrease in the blood high-density lipoprotein cholesterol, an increase in the uric acid, fibrinogen, phosphorus and PTH levels were noted in patients with CKD complicated by renal failure. An increase in the PTH level was found to correlate with a decrease in the filtration function of the kidneys (r=-0.4988; P<0.05) and an increase in the blood serum phosphorus concentration (r=-0.5066; P<0.05). A significant negative relationship was found between the Hb and PTH concentrations (r=-0.4086; P<0.05). A direct correlation was found between the PTH level and the fibrinogen concentrations (r=0.6849; P<0.05), blood C-reactive protein (CRP) level (r=0.5905; P<0.05), as well as the CAP level (r=0.5640; P<0.05).

Conclusion. In patients with CKD, mineral and bone disorders are accompanied by a deterioration in central hemodynamic parameters, the development of a pro-inflammatory status, anemia, hyperuricemia, and dyslipidemia.

Objective. Evaluation of the survival and mortality predictors in patients ≥60 years of age on chronic dialysis (CD).

Material and methods. Data analysis of 199 patients ≥60 years of age on CD: 183 (92%) on program hemodialysis (PHD),
16 (8%) on continuous ambulatory peritoneal dialysis (CAPD).

Results. Median survival was 279 days for PHD, and 650 for CAPD; 1-year survival for PHD was 46.5±3.8%, for CAPD – 81.2±9.8%, 2-year survival for PHD was 33, 3±3.9%, for CAPD – 37.2±13%. Univariate analysis of mortality predictors: PHD vs CAPD method (hazard ratio – RR=1.9, 95% confidence interval – CI 1.04-3.6), age (RR=1.7, 95% CI 1.1-2.6), the presence of type 2 diabetes mellitus – DM2 (RR=1.5, 95% CI 1.1–2.2), the presence of overhydration (RR =1.7, 95% CI 1.2–2.4), pre-dialysis creatinine (Cr) (RR=1.1, 95% CI 1.03–1.2) and urea levels (RR=1.04, 95% CI 1.02–1.05). Multivariate analysis of mortality predictors: age, at the first year of treatment: Cr>1000 µmol/L, urea>45 mmol/L, start of renal replacement therapy (RRT) by PHD.

Conclusion. The peak of mortality in elderly patients occurs in the first year of PHD. CAPD can be considered as 1st line RRT in patients ≥60 years of age. To improve the first year survival of patients on RRT, further study of mortality predictors is required.

Background. Unraveling the mechanisms of bacterial gene expression in vivo that induce pathogenic properties when they are in their host will help to identify new applications in the development of antimicrobials.

Objective. Evaluation of the influence of glucose metabolism in the urinary tract (UT) on the implementation of bacteriuria manifestations.

Material and methods. A retrospective laboratory and PET/CT molecular-cellular analysis of glucose metabolism
in the bladder in conjunction with the features of the clinical manifestations of bacteriuria was carried out.

Results. New data on biosynthetic and metabolic processes that induce the ability of bacteria to various manifestations
of their presence in the human MF have been obtained

Conclusion. The selection of pathogenic properties in typical representatives of the urinary tract microbiota, which determine the clinical form of bacteriuria, may be associated with the features of glucose metabolism in the organs of the urinary system, which needs special study and clarification.

The article is devoted to the choice of nutritional therapy (NT) and nutritional supplementation in pre-dialysis stages of chronic kidney disease (CKD) and in patients on renal replacement therapy (RRT). Modern data on the prevalence and pathogenesis of protein-energy wasting (PEW) in uremia are presented, early detection of PEW and proper prescription of NT are justified. The options for enteral nutrition with oral nutrition supplementation/supplements (ONS) and their effectiveness in the general population of patients with CKD and PEW, and in different phenotypic groups of PEW are discussed. Specific requirements for modern specific renal ONS are presented. Various combinations of ONS with physical exercises and with using of some other nutritional components are described.