Volume 13, Nº 1 (2021)

Objective. provision of the information on the six-year period of the organization of the replacement therapy service for end-stage renal disease in a large metropolis. demonstration of the impact of the covid-19 novel coronavirus pandemic on the state of various types of renal replacement therapy in urban healthcare. Materials and methods. The data from the Moscow nephrological Registty were used in this work. The registry was formed in 2014 and includes data on patients with chronic kidney disease, which are accumulated on the basis of weekly, monthly and annual reports from the heads of departments/centers of nephrology, hemodialysis, and peritoneal dialysis. results. over a 5-year period, before the pandemic of the novel coronavirus infection covid-19, renal replacement therapy developed dynamically: the number of hemodialysis units/centers increased and thus the number of dialysis places increased; the average annual increase in the proportion of patients receiving hemodialysis treatment was 7%; by the beginning of 2020, the number of treated patients on hemodialysis increased by 21%, on peritoneal dialysis - by 53.6%, and the number of patients with a functioning graft increased by 85%. During 2020, as a result of a pandemic of a new coronavirus infection covid-19, the mortality rate of patients increased from an average over a 5-year period of 7.9% to 17.з% in patients on hemodialysis and from 5.2% to 17.2% in patients on peritoneal dialysis. Conclusion. The formation of an urban system for organizing renal replacement therapy requires an integrated approach, including information support (patient registry maintenance), regulatory and methodological support, the development of a network of medical organizations, including on the basis of public-private partnerships (PPP), improving the transportation of patients for hemodialysis procedures. The organized and consistent development of ppp in Moscow has made it possible to significantly increase the provision of renal replacement therapy for patients on programmed hemodialysis. peritoneal dialysis provided exclusively in the medical organizations of the Moscow healthcare department, remains at a stable, insufficiently high level in the shared distribution of renal replacement therapy types. one of the important criteria for the quality of the dialysis therapy method in the urban program is the preparation of patients for kidney transplantation, the development of which remains the main priority for the development of the renal replacement therapy system in Moscow

The current consensus was published in December 2020 in nature reviews (Nephrology). it was developed by the adqi expert group, which included: mitra k. nadim, lui g. Forni, Ravindra l. mehta, Michael j. Connor Jr, Kathleen d. Liu, marlies ostermann, Thomas Rimmele, Alexander Zarbock, Samira bell, Azra bihorac, Vincenzo Cantaluppi, Eric hoste, Faeq Husain-Syed, Michael j. Germain, Stuart l. Goldstein, Shruti Gupta, Michael Joannidis, Kianoush Kashani, jay l. Koyner, Matthieu legrand, nuttha Lumlertgul, Sumit Mohan, neesh Pannu, Zhiyong peng, xose L. perez-Fernandez, peter Pickkers, John Prowle, Thiago reis, Nattachai Srisawat, Ashita Tolwani, Anitha vijayan, Gianluca villa, Li Yang, Claudio Ronco and John a. kellum. it provides clinical guidelines for the diagnosis, prevention and treatment of covid-19-aki, based on current literature data. it also proposes directions for future clinical research to expand understanding of the mechanisms of kidney damage in novel coronavirus infection and improve the outcomes of covid-19 aki. This publication is an unchanged translation of the adqi guidelines for covid-19 associated acute kidney injury. The work carried out is intended to increase the availability of the expert document among a larger number of clinicians specializing in nephrology, internal medicine and intensive care and is of great practical importance in a pandemic.

Objective. evaluation of the relationship between the cytokine profile and the type of left ventricular hypertrophy in renal failure. material and methods. 55 patients with renal failure (RF) and left ventricular hypertrophy (LVH) aged 24 to 79 years, mean age 52.7±13.з years, 36 men (65.4%), 19 women (34.6%), were examined. all patients underwent clinical, echocardiographic and laboratory examination. the blood tumor necrosis factor alpha (TNF-а), interleukin (IL)-io, cystatin c, creatinine, electrolytes, c-reactive protein and uric acid levels, as well as the blood lipids were determined. the glomerular filtration rate (GFR) was calculated based on cystatin c and blood creatinine. depending on the lvh types, patients were divided into two subgroups: concentric (n=20) and eccentric lvh (n=35) with rf. results. in the subgroup of patients with eccentric lvh and rf, the mean values of body mass index (30.4±5.2 versus 28.i±5.7 kg/m2; р=0.013), left ventricle end-diastolic diameter (5.37±o.80 versus 4.96±o.52 cm; р=0.044), and the end diastolic volume (134.4±27.i versus 116.з±26.4 ml; р=0.038) were significantly higher than subgroup with concentric lvh and rf. a significant increase in the interventricular septum (ivs) thickness (1.23±o.20 versus o.94±o.14 cm; р=0.005), the left ventricular posterior wall (LVPW) thickness (1.22±o.19 versus o.93±o.13 cm; р=0.005) and relative wall thickness (RWT) (0.50±0.07 versus 0.35±0.04 U; Р =0.005) WERE OBSERVED IN PATIENTS WITH CONCENTRIC LVH AND RF. A STATISTICALLY SIGNIFICANT DIRECT correlation between the tnf-alpha level and the lv myocardium mass index was recorded (r=0.356; р=0.010), lvpw thickness (R=0.401; P=0.011) AND RWT (R = 0.325; P=0.045). Conclusion. in patients with renal failure and eccentric lvh, an increase in body mass index, left ventricle end-diastolic diameter AND END DIASTOLIC VOLUME WAS RECORDED. MEANWHILE, IN INDIVIDUALS WITH CONCENTRIC LVH AND RF, THERE WAS AN INCREASE IN THE interventricular septum thickness, lv posterior wall thickness, and the relative wall thickness. an increase in lv myocardial mass index was associated with an increase in tnf-alpha level, and an increase in lv wall thickness - WITH INCREASE in il-10 level.

Histidine is the only amino acid, the essentiality of which is still debated. in the 40s of xx century, w.c. rose discovered a paradoxical fact: histidine is essential for rats and other animals, but is non-essential for healthy adults. The essentiality of histidine in infants was soon established. Only this century Japanese biochemists discovered an enzyme that catalyzes the last reaction in the histidine biosynthesis. This enzyme is present in all studied animal species, but with different activity, which is the indicator by which one can judge the essentiality of histidine for a particular organism. at the same time, it has been clearly shown that in patients with uremia, histidine becomes an essential amino acid and its addition to the diet together with amino acids essential for a healthy person improves nitrogen balance. Since then, a number of studies have been conducted on this topic. it was noticed that, unlike other nonessential amino acids, patients with uremia are characterized by low intracellular and plasma histidine concentrations. Patients with uremia are unable to maintain nitrogen balance with a diet low in histidine. in addition, it was found that histidine is an effective "scavenger" for hydroxyl radicals and singlet oxygen and therefore is able to protect low density lipoproteins from oxidation. The anti-inflammatory effect of histidine is also noted in uremia. Although the reasons for low extracellular and intracellular histidine concentrations in uremia are not clear, its oral and intravenous administration has a beneficial effect on nitrogen metabolism. This article examines the nonessentiality of histidine in healthy adults and its essentiality in patients with uremia, as well as unique among amino acids the beneficial effect of histidine in uremia.