581 research outputs found
ΠΠΠΠΠΠΠ’ΠΠΠ¬ ΠΠ’ΠΠΠ‘ΠΠ’ΠΠΠ¬ΠΠΠΠ ΠΠΠͺΠΠΠ ΠΠ ΠΠΠ ΠΠΠ Π‘Π ΠΠΠ‘Π’ΠΠ ΠΠ ΠΠ€ΠΠΠΠΠ’ΠΠΠ ΠΠ Π’ΠΠ ΠΠΠΠ¬ΠΠΠ ΠΠΠΠΠ’ΠΠΠΠΠ Π Π₯ΠΠΠ ΠΠΠΠΠΠΠΠΠΠΠ
Intravascular volume preservation is the first choice measure for the prevention of intradialysis hypotension. At present there are devices that allow continuous monitoring of relative blood volume (RBV) changes during haemodialysis (HD). The aim of this research was to investigate (i) the regularity of RBV curve during haemo- dialysis and (ii) the efficacy of some measures for intravascular volume preservation. In patients with hyperhydration RBV curves were monotone; in all cases relation RBV/ ultrafiltration volume (UF) did not exceed 2,5%/L. In stable patients the RBV curve was immutable in the course of years. Patients with high RBV/UF ratio (>6%/L) formed a high risk group. In these patients stability of RBV was more im- portant and more useful. Isolated UF did not decrease RBV drop, as well as haemodiafiltration online. Albumin administration allows to decrease RBV/UF ratio. After bolus of hypertonic dextrose solution RBV increased for about half of hour. In patients with acute renal injury RBV monitoring was far from reliability in many cases.Β Π¦Π΅Π»ΡΡ Π΄Π°Π½Π½ΠΎΠΉ ΡΠ°Π±ΠΎΡΡ Π±ΡΠ»ΠΎ ΠΎΠΏΡΠ΅Π΄Π΅Π»Π΅Π½ΠΈΠ΅ Π·Π°ΠΊΠΎΠ½ΠΎΠΌΠ΅ΡΠ½ΠΎΡΡΠ΅ΠΉ ΠΈΠ·ΠΌΠ΅Π½Π΅Π½ΠΈΡ ΠΎΡΠ½ΠΎΡΠΈΡΠ΅Π»ΡΠ½ΠΎΠ³ΠΎ ΠΎΠ±ΡΠ΅ΠΌΠ° ΠΊΡΠΎΠ²ΠΈ (ΠΠΠ) Π² Ρ
ΠΎΠ΄Π΅ Π³Π΅ΠΌΠΎΠ΄ΠΈΠ°Π»ΠΈΠ·Π° ΠΈ Π΄Π΅ΠΉΡΡΠ²Π΅Π½Π½ΠΎΡΡΠΈ ΡΠ°Π·Π»ΠΈΡΠ½ΡΡ
ΠΌΠ΅ΡΠΎΠΏΡΠΈΡΡΠΈΠΉ, Π½Π°ΠΏΡΠ°Π²Π»Π΅Π½Π½ΡΡ
Π½Π° ΠΏΠΎΠ΄Π΄Π΅ΡΠΆΠ°Π½ΠΈΠ΅ Π²Π½Ρ- ΡΡΠΈΡΠΎΡΡΠ΄ΠΈΡΡΠΎΠ³ΠΎ ΠΎΠ±ΡΠ΅ΠΌΠ°. ΠΡΡΠ»Π΅ΠΆΠΈΠ²Π°Π½ΠΈΠ΅ ΠΠΠ Π² Ρ
ΠΎΠ΄Π΅ Π³Π΅ΠΌΠΎΠ΄ΠΈΠ°Π»ΠΈΠ·Π° ΡΠ²ΠΈΠ»ΠΎΡΡ Π΄Π΅ΠΉΡΡΠ²Π΅Π½Π½ΠΎΠΉ ΠΌΠ΅ΡΠΎΠΉ ΠΊΠ°ΠΊ Π΄Π»Ρ ΠΏΡΠΎΡΠΈΠ»Π°ΠΊΡΠΈΠΊΠΈ ΠΈΠ½ΡΡΠ°Π΄ΠΈΠ°- Π»ΠΈΠ·Π½ΠΎΠΉ Π³ΠΈΠΏΠΎΡΠ΅Π½Π·ΠΈΠΈ, ΡΠ°ΠΊ ΠΈ ΠΏΡΠΈ ΠΎΡΡΠ°Π±ΠΎΡΠΊΠ΅ Β«ΡΡΡ
ΠΎΠ³ΠΎ Π²Π΅ΡΠ°Β». Π₯Π°ΡΠ°ΠΊΡΠ΅Ρ ΠΊΡΠΈΠ²ΠΎΠΉ ΠΠΠ Ρ ΡΡΠ°Π±ΠΈΠ»ΡΠ½ΡΡ
ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Π½Π° ΠΏΡΠΎΠ³ΡΠ°ΠΌΠΌΠ½ΠΎΠΌ Π³Π΅ΠΌΠΎΠ΄ΠΈΠ°Π»ΠΈΠ·Π΅ ΠΎΡΡΠ°Π΅ΡΡΡ Π½Π΅ΠΈΠ·ΠΌΠ΅Π½Π½ΡΠΌ Π² ΡΠ΅ΡΠ΅Π½ΠΈΠ΅ ΠΌΠ½ΠΎΠ³ΠΈΡ
Π»Π΅Ρ. ΠΡΡΠΎΠΊΠΎΠ΅ (Π±ΠΎΠ»Π΅Π΅ 6% Π½Π° 1 Π»ΠΈΡΡ) ΠΎΡΠ½ΠΎΡΠ΅Π½ΠΈΠ΅ ΠΌΠ°ΠΊΡΠΈΠΌΠ°Π»ΡΠ½ΠΎΠ³ΠΎ ΡΠ½ΠΈΠΆΠ΅Π½ΠΈΡ ΠΠΠ ΠΊ ΠΎΠ±ΡΠ΅ΠΌΡ ΡΠ»ΡΡΡΠ°ΡΠΈΠ»ΡΡΡΠ°ΡΠΈΠΈ (ΠΠΠ/Π£Π€) ΠΏΠΎΠ·Π²ΠΎΠ»ΠΈΠ»ΠΎ Π²ΡΡΠ²ΠΈΡΡ Π³ΡΡΠΏΠΏΡ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ², Ρ ΠΊΠΎΡΠΎΡΡΡ
ΠΎΠ±Π΅Π΄Π½Π΅Π½ΠΈΠ΅ Π²Π½ΡΡΡΠΈΡΠΎΡΡΠ΄ΠΈΡΡΠΎΠ³ΠΎ ΠΎΠ±ΡΠ΅ΠΌΠ° ΡΠ²Π»ΡΠ΅ΡΡΡ ΠΎΡΠ½ΠΎΠ²Π½ΡΠΌ ΠΌΠ΅Ρ
Π°Π½ΠΈΠ·ΠΌΠΎΠΌ ΡΠ°Π·- Π²ΠΈΡΠΈΡ Π°ΡΡΠ΅ΡΠΈΠ°Π»ΡΠ½ΠΎΠΉ Π³ΠΈΠΏΠΎΡΠ΅Π½Π·ΠΈΠΈ Π² Ρ
ΠΎΠ΄Π΅ ΡΠ΅Π°Π½ΡΠΎΠ² Π»Π΅ΡΠ΅Π½ΠΈΡ. ΠΠ·ΠΎΠ»ΠΈΡΠΎΠ²Π°Π½Π½Π°Ρ ΡΠ»ΡΡΡΠ°ΡΠΈΠ»ΡΡΡΠ°ΡΠΈΡ ΠΈ Π³Π΅ΠΌΠΎΠ΄ΠΈΠ°- ΡΠΈΠ»ΡΡΡΠ°ΡΠΈΡ on line Π½Π΅ ΠΏΠΎΠ·Π²ΠΎΠ»ΠΈΠ»ΠΈ ΡΠ»ΡΡΡΠΈΡΡ Π²ΠΎΡΠΏΠΎΠ»Π½Π΅Π½ΠΈΠ΅ Π²Π½ΡΡΡΠΈΡΠΎΡΡΠ΄ΠΈΡΡΠΎΠ³ΠΎ ΠΎΠ±ΡΠ΅ΠΌΠ°. ΠΠ²Π΅Π΄Π΅Π½ΠΈΠ΅ ΡΠ°ΡΡΠ²ΠΎ- ΡΠ° Π°Π»ΡΠ±ΡΠΌΠΈΠ½Π° ΠΏΠΎΠ·Π²ΠΎΠ»ΡΠ»ΠΎ ΡΠ½ΠΈΠ·ΠΈΡΡ ΡΠ΅ΠΌΠΏ ΡΠ½ΠΈΠΆΠ΅Π½ΠΈΡ ΠΠΠ, Π° Π±ΠΎΠ»ΡΡΠ½ΠΎΠ΅ Π²Π²Π΅Π΄Π΅Π½ΠΈΠ΅ Π³ΠΈΠΏΠ΅ΡΡΠΎΠ½ΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ ΡΠ°ΡΡΠ²ΠΎΡΠ° Π³Π»ΡΠΊΠΎΠ·Ρ ΠΏΠΎΠ²ΡΡΠ°Π»ΠΎ ΠΠΠ Π½Π° ΡΡΠΎΠΊ ΠΎΠΊΠΎΠ»ΠΎ ΠΏΠΎΠ»ΡΡΠ°ΡΠ°. Π£ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ ΠΎΡΡΡΡΠΌ ΠΏΠΎΠ²ΡΠ΅ΠΆΠ΄Π΅Π½ΠΈΠ΅ΠΌ ΠΏΠΎΡΠ΅ΠΊ ΠΏΠΎΠΊΠ°Π·Π°ΡΠ΅Π»Ρ ΠΠΠ Π½Π΅ Π²ΡΠ΅Π³Π΄Π° ΠΎΠΊΠ°Π·ΡΠ²Π°Π»ΡΡ Π΄ΠΎΡΡΠΎΠ²Π΅ΡΠ½ΡΠΌ.
ΠΠΏΡΠΈΠΌΠΈΠ·Π°ΡΠΈΡ ΠΊΠΎΠ½Π²Π΅ΠΊΡΠΈΠΎΠ½Π½ΠΎΠ³ΠΎ ΠΏΠΎΡΠΎΠΊΠ° ΠΏΡΠΈ ΠΎΠ½Π»Π°ΠΉΠ½ Π³Π΅ΠΌΠΎΠ΄ΠΈΠ°ΡΠΈΠ»ΡΡΡΠ°ΡΠΈΠΈ
Objective: to evaluate the dependence of the magnitude of convection flow in online hemodiafiltration (OLHDF) on ultrafiltration control method and patientsβ individual characteristics. Materials and methods. The study included 36 stable dialysis patients (20 male and 16 female). The substitution rate was conducted manually based on transmembrane pressure (TMP). In some cases, devices with automatic filtration rate control unit AutoSub plus were used. The filtration rate (FR), TMP, blood flow rate (Qb), specific filtration rate (SFR, m/l/min/mm Hgβ1 ) were recorded. Results. The maximum SFR in various patients ranged from 0.51 to 0.80 ml/min/mm Hgβ1 ; average value was 0.62 Β± 0.07 ml/min/mm Hgβ1 . There was significant correlation of SFR with hemoglobin level (r = β0.55). SFR reduced during hemodiafiltration (on average β by 23 Β± 4%). SFR was significantly affected by Qb (r = 0.70). Maximum SFR was achieved with a TMP of 140β220 mm Hg; with TMP over 250 mm Hg, a decrease in SFR was noted, an increase in Qb was required for further increase in FR. Individual stability of SFR was noted during serial observations; fluctuations in a particular patient did not exceed 10%. Substitution volume for the HDF session was 18.0 Β± 3.3 L, the FR/Qb ratio was 24.7 Β± 5.2%. Substitution volume of 21 L was not achieved in 17 of 36 patients. The use of automatic FR adjustment system made it possible to increase the substitution volume (SV) by 12β18%. Conclusion. Achieving maximum convection volume in OLHDF requires individualizing treatment parameters. The use of FR automatic control allows maximum possible convection flow.Π¦Π΅Π»Ρ: ΠΈΠ·ΡΡΠΈΡΡ Π·Π°Π²ΠΈΡΠΈΠΌΠΎΡΡΡ Π²Π΅Π»ΠΈΡΠΈΠ½Ρ ΠΊΠΎΠ½Π²Π΅ΠΊΡΠΈΠΎΠ½Π½ΠΎΠ³ΠΎ ΠΏΠΎΡΠΎΠΊΠ° ΠΏΡΠΈ ΠΎΠ½Π»Π°ΠΉΠ½ Π³Π΅ΠΌΠΎΠ΄ΠΈΠ°ΡΠΈΠ»ΡΡΡΠ°ΡΠΈΠΈ (ΠΎΠ»ΠΠΠ€) ΠΎΡ ΡΠΏΠΎΡΠΎΠ±Π° ΡΠΏΡΠ°Π²Π»Π΅Π½ΠΈΡ ΡΠ»ΡΡΡΠ°ΡΠΈΠ»ΡΡΡΠ°ΡΠΈΠ΅ΠΉ ΠΈ ΠΈΠ½Π΄ΠΈΠ²ΠΈΠ΄ΡΠ°Π»ΡΠ½ΡΡ
ΠΎΡΠΎΠ±Π΅Π½Π½ΠΎΡΡΠ΅ΠΉ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ². ΠΠ°ΡΠ΅ΡΠΈΠ°Π»Ρ ΠΈ ΠΌΠ΅ΡΠΎΠ΄Ρ. Π ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠ΅ Π±ΡΠ»ΠΈ Π²ΠΊΠ»ΡΡΠ΅Π½Ρ 36 ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² (20 ΠΌΡΠΆΡΠΈΠ½ ΠΈ 16 ΠΆΠ΅Π½ΡΠΈΠ½), Π½Π°Ρ
ΠΎΠ΄ΡΡΠΈΡ
ΡΡ Π½Π° Π»Π΅ΡΠ΅Π½ΠΈΠΈ ΠΏΡΠΎΠ³ΡΠ°ΠΌΠΌΠ½ΡΠΌ Π³Π΅ΠΌΠΎΠ΄ΠΈΠ°Π»ΠΈΠ·ΠΎΠΌ. Π£ΠΏΡΠ°Π²Π»Π΅Π½ΠΈΠ΅ ΡΠΊΠΎΡΠΎΡΡΡΡ Π·Π°ΠΌΠ΅ΡΠ΅Π½ΠΈΡ ΠΏΡΠΎΠ²ΠΎΠ΄ΠΈΠ»ΠΎΡΡ Π² ΡΡΡΠ½ΠΎΠΌ ΡΠ΅ΠΆΠΈΠΌΠ΅ Π½Π° ΠΎΡΠ½ΠΎΠ²Π°Π½ΠΈΠΈ ΠΏΠΎΠΊΠ°Π·Π°ΡΠ΅Π»Π΅ΠΉ ΡΡΠ°Π½ΡΠΌΠ΅ΠΌΠ±ΡΠ°Π½Π½ΠΎΠ³ΠΎ Π΄Π°Π²Π»Π΅Π½ΠΈΡ (Π’ΠΠ). Π ΡΡΠ΄Π΅ ΡΠ»ΡΡΠ°Π΅Π² ΠΈΡΠΏΠΎΠ»ΡΠ·ΠΎΠ²Π°Π»ΠΈΡΡ Π°ΠΏΠΏΠ°ΡΠ°ΡΡ Ρ Π±Π»ΠΎΠΊΠΎΠΌ Π°Π²ΡΠΎΠΌΠ°ΡΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ ΡΠΏΡΠ°Π²Π»Π΅Π½ΠΈΡ ΡΠΊΠΎΡΠΎΡΡΡΡ ΡΠΈΠ»ΡΡΡΠ°ΡΠΈΠΈ (Π‘Π€) AutoSub plus. Π€ΠΈΠΊΡΠΈΡΠΎΠ²Π°Π»ΠΈΡΡ Π‘Π€, Π’ΠΠ, ΡΠΊΠΎΡΠΎΡΡΡ ΠΊΡΠΎΠ²ΠΎΡΠΎΠΊΠ° (Π‘Π), ΡΠ΄Π΅Π»ΡΠ½Π°Ρ ΡΠΊΠΎΡΠΎΡΡΡ ΡΠΈΠ»ΡΡΡΠ°ΡΠΈΠΈ (Π£Π‘Π€, ΠΌΠ»/ΠΌΠΈΠ½/ΠΌΠΌ ΡΡ. ΡΡ.β1 ). Π Π΅Π·ΡΠ»ΡΡΠ°ΡΡ. ΠΠ°ΠΊΡΠΈΠΌΠ°Π»ΡΠ½Π°Ρ Π£Π‘Π€ Ρ ΡΠ°Π·Π»ΠΈΡΠ½ΡΡ
ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² ΠΊΠΎΠ»Π΅Π±Π°Π»Π°ΡΡ Π² ΠΏΡΠ΅Π΄Π΅Π»Π°Ρ
0,51β0,80 ΠΌΠ»/ΠΌΠΈΠ½/ΠΌΠΌ ΡΡ. ΡΡ.β1 , ΡΡΠ΅Π΄Π½Π΅Π΅ Π·Π½Π°ΡΠ΅Π½ΠΈΠ΅ ΡΠΎΡΡΠ°Π²ΠΈΠ»ΠΎ 0,62 Β± 0,07 ΠΌΠ»/ΠΌΠΈΠ½/ΠΌΠΌ ΡΡ. ΡΡ.β1 . ΠΡΠ»Π° ΠΎΡΠΌΠ΅ΡΠ΅Π½Π° Π·Π½Π°ΡΠΈΠΌΠ°Ρ ΠΊΠΎΡΡΠ΅Π»ΡΡΠΈΡ Π£Π‘Π€ Ρ ΡΡΠΎΠ²Π½Π΅ΠΌ Π³Π΅ΠΌΠΎΠ³Π»ΠΎΠ±ΠΈΠ½Π° (r = β0,55). Π ΡΠ΅ΡΠ΅Π½ΠΈΠ΅ ΠΏΡΠΎΡΠ΅Π΄ΡΡΡ ΠΎΡΠΌΠ΅ΡΠ°Π»ΠΎΡΡ ΡΠ½ΠΈΠΆΠ΅Π½ΠΈΠ΅ Π£Π‘Π€ (Π² ΡΡΠ΅Π΄Π½Π΅ΠΌ β Π½Π° 23 Β± 4%). ΠΠ° Π²Π΅Π»ΠΈΡΠΈΠ½Ρ Π£Π‘Π€ ΠΎΠΊΠ°Π·ΡΠ²Π°Π»Π° ΡΡΡΠ΅ΡΡΠ²Π΅Π½Π½ΠΎΠ΅ Π²Π»ΠΈΡΠ½ΠΈΠ΅ Π‘Π (r = 0,70). ΠΠ°ΠΊΡΠΈΠΌΠ°Π»ΡΠ½Π°Ρ Π£Π‘Π€ Π΄ΠΎΡΡΠΈΠ³Π°Π»Π°ΡΡ ΠΏΡΠΈ Π’ΠΠ 140β220 ΠΌΠΌ ΡΡ. ΡΡ., ΠΏΡΠΈ Π’ΠΠ ΡΠ²ΡΡΠ΅ 250 ΠΌΠΌ ΡΡ. ΡΡ. ΠΎΡΠΌΠ΅ΡΠ°Π»ΠΎΡΡ ΠΏΠ°Π΄Π΅Π½ΠΈΠ΅ Π£Π‘Π€, ΠΈ Π΄Π»Ρ Π΄Π°Π»ΡΠ½Π΅ΠΉΡΠ΅Π³ΠΎ ΠΏΡΠΈΡΠΎΡΡΠ° Π‘Π€ ΡΡΠ΅Π±ΠΎΠ²Π°Π»ΠΎΡΡ ΡΠ²Π΅Π»ΠΈΡΠ΅Π½ΠΈΠ΅ ΡΠΊΠΎΡΠΎΡΡΠΈ ΠΊΡΠΎΠ²ΠΎΡΠΎΠΊΠ°. ΠΡΠΈ ΡΠ΅ΡΠΈΠΉΠ½ΡΡ
Π½Π°Π±Π»ΡΠ΄Π΅Π½ΠΈΡΡ
Π±ΡΠ»Π° ΠΎΡΠΌΠ΅ΡΠ΅Π½Π° ΠΈΠ½Π΄ΠΈΠ²ΠΈΠ΄ΡΠ°Π»ΡΠ½Π°Ρ ΡΡΠ°Π±ΠΈΠ»ΡΠ½ΠΎΡΡΡ Π£Π‘Π€, ΠΊΠΎΠ»Π΅Π±Π°Π½ΠΈΡ Ρ ΠΊΠΎΠ½ΠΊΡΠ΅ΡΠ½ΠΎΠ³ΠΎ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠ° Π½Π΅ ΠΏΡΠ΅Π²ΡΡΠ°Π»ΠΈ 10%. ΠΠ±ΡΠ΅ΠΌ Π·Π°ΠΌΠ΅ΡΠ΅Π½ΠΈΡ Π·Π° ΡΠ΅Π°Π½Ρ ΠΠΠ€ ΡΠΎΡΡΠ°Π²ΠΈΠ» 18,0 Β± 3,3 Π», ΡΠΎΠΎΡΠ½ΠΎΡΠ΅Π½ΠΈΠ΅ Π‘Π€/Π‘Π 24,7 Β± 5,2%, ΠΏΡΠΈ ΡΡΠΎΠΌ Ρ 17 ΠΈΠ· 36 ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Π½Π΅ Π±ΡΠ» Π΄ΠΎΡΡΠΈΠ³Π½ΡΡ ΠΎΠ±ΡΠ΅ΠΌ Π·Π°ΠΌΠ΅ΡΠ΅Π½ΠΈΡ 21 Π». ΠΡΠΈΠΌΠ΅Π½Π΅Π½ΠΈΠ΅ Π°Π²ΡΠΎΠΌΠ°ΡΠΈΡΠ΅ΡΠΊΠΎΠΉ ΡΠΈΡΡΠ΅ΠΌΡ ΡΠ΅Π³ΡΠ»ΠΈΡΠΎΠ²ΠΊΠΈ Π‘Π€ ΠΏΠΎΠ·Π²ΠΎΠ»ΡΠ»ΠΎ ΡΠ²Π΅Π»ΠΈΡΠΈΡΡ ΠΎΠ±ΡΠ΅ΠΌ Π·Π°ΠΌΠ΅ΡΠ΅Π½ΠΈΡ (ΠΠ) Π½Π° 12β18%. ΠΠ°ΠΊΠ»ΡΡΠ΅Π½ΠΈΠ΅. ΠΠΎΡΡΠΈΠΆΠ΅Π½ΠΈΠ΅ ΠΌΠ°ΠΊΡΠΈΠΌΠ°Π»ΡΠ½ΠΎΠ³ΠΎ ΠΊΠΎΠ½Π²Π΅ΠΊΡΠΈΠΎΠ½Π½ΠΎΠ³ΠΎ ΠΎΠ±ΡΠ΅ΠΌΠ° ΠΏΡΠΈ ΠΎΠ»ΠΠΠ€ ΡΡΠ΅Π±ΡΠ΅Ρ ΠΈΠ½Π΄ΠΈΠ²ΠΈΠ΄ΡΠ°Π»ΠΈΠ·Π°ΡΠΈΠΈ ΠΏΠ°ΡΠ°ΠΌΠ΅ΡΡΠΎΠ² Π»Π΅ΡΠ΅Π½ΠΈΡ. ΠΡΠΈΠΌΠ΅Π½Π΅Π½ΠΈΠ΅ Π°Π²ΡΠΎΠΌΠ°ΡΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ ΡΠΏΡΠ°Π²Π»Π΅Π½ΠΈΡ Π‘Π€ ΠΏΠΎΠ·Π²ΠΎΠ»ΡΠ΅Ρ ΠΎΠ±Π΅ΡΠΏΠ΅ΡΠΈΡΡ ΠΌΠ°ΠΊΡΠΈΠΌΠ°Π»ΡΠ½ΠΎ Π²ΠΎΠ·ΠΌΠΎΠΆΠ½ΡΠΉ ΠΊΠΎΠ½Π²Π΅ΠΊΡΠΈΠΎΠ½Π½ΡΠΉ ΠΏΠΎΡΠΎΠΊ
ΠΡΡΠΎΠΊΠ°Ρ ΠΏΡΠΎΠ½ΠΈΡΠ°Π΅ΠΌΠΎΡΡΡ ΠΌΠ΅ΠΌΠ±ΡΠ°Π½ Π΄Π»Ρ Π³Π΅ΠΌΠΎΠ΄ΠΈΠ°Π»ΠΈΠ·Π°: ΠΏΠ»ΡΡΡ ΠΈ ΠΌΠΈΠ½ΡΡΡ
Up-to-date technologies have led to significant improvement of haemodialysis membranes biocompatibility and permeability. The new classes of membranes, high cut-off and middle cut-off, allow enhanced removal of middle molecules such as Ξ²2-microglobulin and even larger molecules. High membrane permeability along with the wide use of convective modalities are accompanied by increased albumin loss during dialysis. What is the acceptable upper limit for this loss and where is the right balance between the benefit of enhanced uremic substances removal and potential adverse effects of albumin deprivation are the active areas of research.Π‘ΠΎΠ²ΡΠ΅ΠΌΠ΅Π½Π½ΡΠ΅ ΡΠ΅Ρ
Π½ΠΎΠ»ΠΎΠ³ΠΈΠΈ ΠΏΡΠΎΠΈΠ·Π²ΠΎΠ΄ΡΡΠ²Π° ΠΌΠ΅ΠΌΠ±ΡΠ°Π½ Π΄Π»Ρ Π³Π΅ΠΌΠΎΠ΄ΠΈΠ°Π»ΠΈΠ·Π° ΠΏΠΎΠ·Π²ΠΎΠ»ΠΈΠ»ΠΈ ΡΡΡΠ΅ΡΡΠ²Π΅Π½Π½ΠΎ ΠΏΠΎΠ²ΡΡΠΈΡΡ ΠΈΡ
Π±ΠΈΠΎΡΠΎΠ²ΠΌΠ΅ΡΡΠΈΠΌΠΎΡΡΡ ΠΈ ΠΏΡΠΎΠ½ΠΈΡΠ°Π΅ΠΌΠΎΡΡΡ. ΠΠΎΠ²ΡΠ΅ ΡΠ°Π·Π½ΠΎΠ²ΠΈΠ΄Π½ΠΎΡΡΠΈ ΠΌΠ΅ΠΌΠ±ΡΠ°Π½ β Ρ Π²ΡΡΠΎΠΊΠΎΠΉ ΠΈ ΡΡΠ΅Π΄Π½Π΅ΠΉ ΡΠΎΡΠΊΠ°ΠΌΠΈ ΠΎΡΡΠ΅ΡΠ΅Π½ΠΈΡ ΠΏΠΎ ΠΌΠΎΠ»Π΅ΠΊΡΠ»ΡΡΠ½ΠΎΠΉ ΠΌΠ°ΡΡΠ΅ ΠΏΡΠΎΡΠ΅ΠΈΠ²Π°ΡΡΠΈΡ
ΡΡ Π²Π΅ΡΠ΅ΡΡΠ² β ΠΏΠΎΠ·Π²ΠΎΠ»ΡΡΡ ΡΡΡΠ΅ΠΊΡΠΈΠ²Π½ΠΎ ΡΠ΄Π°Π»ΡΡΡ Π½Π΅ ΡΠΎΠ»ΡΠΊΠΎ ΡΡΠ΅Π΄Π½ΠΈΠ΅ ΠΌΠΎΠ»Π΅ΠΊΡΠ»Ρ, ΡΠ°ΠΊΠΈΠ΅ ΠΊΠ°ΠΊ Ξ²2 -ΠΌΠΈΠΊΡΠΎΠ³Π»ΠΎΠ±ΡΠ»ΠΈΠ½, Π½ΠΎ ΠΈ Π±ΠΎΠ»Π΅Π΅ ΡΠ°Π·ΠΌΠ΅ΡΠ½ΡΠ΅ ΠΌΠΎΠ»Π΅ΠΊΡΠ»Ρ. ΠΡΡΠΎΠΊΠ°Ρ ΠΏΡΠΎΠ½ΠΈΡΠ°Π΅ΠΌΠΎΡΡΡ ΡΠΎΠ²ΡΠ΅ΠΌΠ΅Π½Π½ΡΡ
Π΄ΠΈΠ°Π»ΠΈΠ·Π½ΡΡ
ΠΌΠ΅ΠΌΠ±ΡΠ°Π½ ΠΈ ΡΠΈΡΠΎΠΊΠΎΠ΅ Π²Π½Π΅Π΄ΡΠ΅Π½ΠΈΠ΅ ΠΊΠΎΠ½Π²Π΅ΠΊΡΠΈΠ²Π½ΡΡ
ΠΌΠ΅ΡΠΎΠ΄ΠΈΠΊ ΡΠΎΠΏΡΡΠΆΠ΅Π½Ρ Ρ ΠΏΠΎΠ²ΡΡΠ΅Π½Π½ΠΎΠΉ ΠΏΠΎΡΠ΅ΡΠ΅ΠΉ Π°Π»ΡΠ±ΡΠΌΠΈΠ½Π° Π² Ρ
ΠΎΠ΄Π΅ ΡΠ΅Π°Π½ΡΠΎΠ² Π»Π΅ΡΠ΅Π½ΠΈΡ. ΠΠ°ΠΊΠΎΠΉ ΡΡΠΎΠ²Π΅Π½Ρ ΡΠ°ΠΊΠΈΡ
ΠΏΠΎΡΠ΅ΡΡ ΠΌΠΎΠΆΠ½ΠΎ ΡΡΠΈΡΠ°ΡΡ ΠΏΡΠΈΠ΅ΠΌΠ»Π΅ΠΌΡΠΌ ΠΈ Π³Π΄Π΅ Π½Π°Ρ
ΠΎΠ΄ΠΈΡΡΡ ΡΠΎΡΠΊΠ° ΡΠ°Π²Π½ΠΎΠ²Π΅ΡΠΈΡ ΠΌΠ΅ΠΆΠ΄Ρ ΠΏΡΠ΅ΠΈΠΌΡΡΠ΅ΡΡΠ²Π°ΠΌΠΈ ΠΏΠΎΠ²ΡΡΠ΅Π½Π½ΠΎΠ³ΠΎ Π²ΡΠ²Π΅Π΄Π΅Π½ΠΈΡ ΡΡΠ΅ΠΌΠΈΡΠ΅ΡΠΊΠΈΡ
ΡΠΎΠ΅Π΄ΠΈΠ½Π΅Π½ΠΈΠΉ ΠΈ ΠΏΠΎΡΠ΅Π½ΡΠΈΠ°Π»ΡΠ½ΠΎΠΉ ΠΎΠΏΠ°ΡΠ½ΠΎΡΡΡΡ ΠΈΠ·Π±ΡΡΠΎΡΠ½ΠΎΠ³ΠΎ ΠΏΡΠΎΡΠ΅ΠΈΠ²Π°Π½ΠΈΡ Π°Π»ΡΠ±ΡΠΌΠΈΠ½Π° β ΡΡΠΈ Π²ΠΎΠΏΡΠΎΡΡ ΡΡΠ΅Π±ΡΡΡ Π΄Π°Π»ΡΠ½Π΅ΠΉΡΠΈΡ
ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠΉ
ΠΠΠ’ΠΠΠΠΠΠ£ΠΠ―Π¦ΠΠ― ΠΠ Π ΠΠΠΠΠ‘Π’ΠΠ’ΠΠΠ¬ΠΠΠ ΠΠΠ§ΠΠ§ΠΠΠ Π’ΠΠ ΠΠΠΠ: ΠΠΠΠ‘Π‘ΠΠ§ΠΠ‘ΠΠΠ ΠΠΠΠ₯ΠΠΠ« Π ΠΠΠΠ«Π ΠΠΠΠΠΠΠΠΠ‘Π’Π
Clotting prevention is one of the key problems in renal replacement therapy. In this review traditional heparini- zation and its complications, low molecular weight heparins, which are wide used in programme haemodialysis, treatment without anticoagulants, regional citrate anticoagulantion, as well as new alternative anticoagulants are considered.Β ΠΡΠΈΠΌΠ΅Π½Π΅Π½ΠΈΠ΅ Π°Π½ΡΠΈΠΊΠΎΠ°Π³ΡΠ»ΡΠ½ΡΠΎΠ² ΡΠ²Π»ΡΠ΅ΡΡΡ ΠΎΠ΄Π½ΠΈΠΌ ΠΈΠ· ΠΊΠ»ΡΡΠ΅Π²ΡΡ
ΠΌΠΎΠΌΠ΅Π½ΡΠΎΠ² ΠΏΡΠΈ Π·Π°ΠΌΠ΅ΡΡΠΈΡΠ΅Π»ΡΠ½ΠΎΠΉ ΠΏΠΎΡΠ΅ΡΠ½ΠΎΠΉ ΡΠ΅- ΡΠ°ΠΏΠΈΠΈ. Π Π΄Π°Π½Π½ΠΎΠΌ ΠΎΠ±Π·ΠΎΡΠ΅ Π»ΠΈΡΠ΅ΡΠ°ΡΡΡΡ ΡΠ°ΡΡΠΌΠΎΡΡΠ΅Π½Ρ ΡΡΠ°Π΄ΠΈΡΠΈΠΎΠ½Π½Π°Ρ Π³Π΅ΠΏΠ°ΡΠΈΠ½ΠΈΠ·Π°ΡΠΈΡ ΠΈ Π΅Π΅ ΠΎΡΠ»ΠΎΠΆΠ½Π΅Π½ΠΈΡ, Π½ΠΈΠ·ΠΊΠΎ- ΠΌΠΎΠ»Π΅ΠΊΡΠ»ΡΡΠ½ΡΠ΅ Π³Π΅ΠΏΠ°ΡΠΈΠ½Ρ, ΡΠΈΡΠΎΠΊΠΎ ΠΏΡΠΈΠΌΠ΅Π½ΡΡΡΠΈΠ΅ΡΡ Π² ΠΏΡΠΎΠ³ΡΠ°ΠΌΠΌΠ½ΠΎΠΌ Π³Π΅ΠΌΠΎΠ΄ΠΈΠ°Π»ΠΈΠ·Π΅, Π±Π΅Π·Π³Π΅ΠΏΠ°ΡΠΈΠ½ΠΎΠ²ΡΠΉ Π΄ΠΈΠ°Π»ΠΈΠ·, ΡΠ΅Π³ΠΈΠΎΠ½Π°ΡΠ½Π°Ρ ΡΠΈΡΡΠ°ΡΠ½Π°Ρ Π°Π½ΡΠΈΠΊΠΎΠ°Π³ΡΠ»ΡΡΠΈΡ, Π° ΡΠ°ΠΊΠΆΠ΅ ΡΠΎΠ²ΡΠ΅ΠΌΠ΅Π½Π½ΡΠ΅ Π°Π»ΡΡΠ΅ΡΠ½Π°ΡΠΈΠ²Π½ΡΠ΅ Π°Π½ΡΠΈΠΊΠΎΠ°Π³ΡΠ»ΡΠ½ΡΡ.
ACUTE KIDNEY INJURY AFTER HEART TRANSPLANTATION: RISK FACTORS AND RENAL REPLACEMENT THERAPY
Acute kidney injury (AKI) is a frequent complication after heart transplantation (HT). For the identification of risk factors of AKI and optimal modes of renal replacement therapy (RRT) 86 HT data was analyzed. AKI was observed in 37 cases. The main risk factors were renal failure before HT, heart transplant dysfunction and requirement in mechanical support. Continuous RRT was preferable due to the best control of patientβs volumes. The widening of indications for RRT was associated with better survival. In the cases of AKI occurrence the long-term (>10 years) prognosis was worsening significantly
ACUTE KIDNEY INJURY: HISTORICAL ASPECTS AND DIAGNOSTIC CRITERIA
The in-depth review is dedicated to the acute kidney injury. This conception is wider than acute renal failure. Even minor decline of renal function bias outcomes, so early diagnosis of acute renal injury is exceedingly important. The new markers of kidney injury are actively investigated. RIFLE criteria provide universal approach to a problem at first, and allow comparison of study results at second
PREVENTION AND TREATMENT OF ACUTE KIDNEY INJURY AFTER CARDIAC SURGERY WITH CARDIOPULMONARY BYPASS AND HEART TRANSPLANTATION
Acute renal failure is one of the most frequent and life-threatening complications after cardiac surgery, which determines the outcome. The priority is the development of preventive measures and best treatments, in the first place β renal replacement therapy (RRT). To date, any medicines with proven nephroprotective properties is unknown. According to some reports, the use of prophylactic dialysis reduces the need for postoperative RRT. Continuous and intermittent methods of RRT are complementary. Early or even prophylactic use of RRT with increasing effectiveness are the current trends. However, it is unclear where is the limit of extended indications for RRT and what it`s optimal dose
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