Rehabilitation after COVID-19. Resolution of the International Expert Council of the Eurasian Association of Therapists and the Russian Society of Cardiology

By the middle of 2021, the official global number of coronavirus disease 2019 (COVID-19) patients was close to 230 million, but the number accounting for asymptomatic patients was much higher. Consequences and rehabilitation after COVID-19 are of particular interest and raise many controversial and unresolved issues. On May 18, 2021, the Eurasian Association of Therapists organized an international panel of experts to analyze challenges associated with the post-COVID-19 period. This panel aimed to develop approaches to identify gaps in the discussed issues. This interdisciplinary team of leading experts reviewed the current literature and presented their data to formulate practical guidance on management of patients after COVID-19. The panel of experts also presented recommendations on how to implement the gained knowledge into health care practices

Cardiovascular problems in dialysis patients - focus on correcting hyperphosphatemia

Mineral-bone disorder in chronic kidney disease (CKD-MBD) is one of the most important factor determining prognosis in dialysis patients. CKD-MBD syndrome occurs at the CKD stage 2 and reaches its maximum in patients with end-stage renal disease. Currently, hyperphosphatemia plays a central role in the pathogenesis of CKD-MBD(the so-called “phosphate-centric paradigm”). In turn, hyperphosatemia leads to an increase in the level of phosphaturic hormone - fibroblast growth factor type 23 (FGF23). FGF23 causes remodeling and fibrosis of the myocardium, renal parenchyma, the development of calcification and vascular atherosclerosis. Thus, hyperphosphatemia, indirectly, through an increase in the level of FGF23, is one of the most important manifestation of progressive CKD and a significant factor of high overall and cardiovascular morbidity and mortality in this cohort of patients. Given that cardiovascular events are the main cause of mortality in patients on renal replacement therapy with dialysis, correction of hyperphosphatemia is a prerequisite for successful monitoring of this group of patients and influencing prognosis. The review presents the main approaches for the correction of hyperphosphatemia in CKD, such as nutritional correction, modification of dialysis methods, and prescribing of phosphate binders. The advantages of calcium-free phosphate-binding agents are considered in details and had compared with effects of containing calcium phosphate binders.The treatment of hyperphosphatemia should be approached comprehensively, using optimal dialysis therapy regimens, training and monitoring dietary phosphate consumption with the obligatory use of phosphate binders that are most effective and well tolerated

SELECTIVE PARENCHYMA CLAMPING TECHNIQUE AS AN ALTERNATIVE TO TRADITIONAL VASCULAR CLAMPING DURING PARTIAL NEPHRECTOMY

The aim of our study is to introduce a safe and easy way to perform partial nephrectomy via different approaches with a set of our specially engineered instruments for parenchyma clamping. Between January 2011 and October 2013 we performed a total number of 110 open, laparoscopic and robotic partial nephrectomies (PN) in patients with RCC stage T1-2N0M0. Eighty-six and 24 patients underwent PN with traditional vascular clamping (VC group) and selective parenchyma clamping (PC group), respectively. We worked out 3 types renal parenchyma clamps (patented inventions): one for laparoscopic/robotic PN and two kinds for open procedures (upper/lower pole and middle segment of kidney). We measured glomerular filtration rate (GFR) before the procedure and 24 hours and 1 year after. We also measured operative time, blood loss, warm ischemia time and parenchyma clamping time. In VC group depression of GFR 24 hours and 1 year after the operation was 22% and 33%, respectively. Deterioration of GFR 24 hours and 1 year after surgery in PC group was 5% and 12%, respectively. In both groups patients didn’t face any perioperative complications or reinterventions. Cancer-specific survival rate was 100% in both groups during 1 year follow-up. NSS can be performed in a safe manner under regional ischemia with selective parenchyma clamping. Regional ischemia shows better functional results immediately and 1 year after the surgery and can be achieved by using specially designed parenchyma clamps during open, laparoscopic and robotic partial nephrectomy

A randomized, open-label trial of iron isomaltoside 1000 (Monofer®) compared with iron sucrose (Venofer®) as maintenance therapy in haemodialysis patients

BACKGROUND: Iron deficiency anaemia is common in patients with chronic kidney disease, and intravenous iron is the preferred treatment for those on haemodialysis. The aim of this trial was to compare the efficacy and safety of iron isomaltoside 1000 (Monofer®) with iron sucrose (Venofer®) in haemodialysis patients. METHODS: This was an open-label, randomized, multicentre, non-inferiority trial conducted in 351 haemodialysis subjects randomized 2 : 1 to either iron isomaltoside 1000 (Group A) or iron sucrose (Group B). Subjects in Group A were equally divided into A1 (500 mg single bolus injection) and A2 (500 mg split dose). Group B were also treated with 500 mg split dose. The primary end point was the proportion of subjects with haemoglobin (Hb) in the target range 9.5–12.5 g/dL at 6 weeks. Secondary outcome measures included haematology parameters and safety parameters. RESULTS: A total of 351 subjects were enrolled. Both treatments showed similar efficacy with >82% of subjects with Hb in the target range (non-inferiority, P = 0.01). Similar results were found when comparing subgroups A1 and A2 with Group B. No statistical significant change in Hb concentration was found between any of the groups. There was a significant increase in ferritin from baseline to Weeks 1, 2 and 4 in Group A compared with Group B (Weeks 1 and 2: P < 0.001; Week 4: P = 0.002). There was a significant higher increase in reticulocyte count in Group A compared with Group B at Week 1 (P < 0.001). The frequency, type and severity of adverse events were similar. CONCLUSIONS: Iron isomaltoside 1000 and iron sucrose have comparative efficacy in maintaining Hb concentrations in haemodialysis subjects and both preparations were well tolerated with a similar short-term safety profile