Activation of chronic inflammation and comorbidity in end-stage renal disease patients treated with continuous ambulatory peritoneal dialysis.

The aim of the work was to determine the blood serum pro-inflammatory cytokine profile and to study their relationship with comorbidity and mortality in end-stage renal disease (ESRD) patients treated with continuous ambulatory peritoneal dialysis (CAPD). Ninety three ESRD patients treated with CAPD during 2012-2019 were included in the cohort prospective open study. The study was conducted in two stages. At the first stage, the determination of TNF-α and IL-6 levels was conducted and study of comorbidity, its quantitative assessment, baseline clinical and laboratory parameters was made. A modified polymorbidity index (MPI) which determined the quantitative assessment of comorbidity was calculated as the number of diseases per one patient excluding ESRD and its reasons. At the second stage, considering the baseline values of the studied cytokines, a prospective study of the dynamics of the prevalence of comorbid pathology, the value of MPI and mortality rate was carried out. The average duration of prospective follow-up was 26.4±6.8 months. Serum cytokines levels were determined by ELISA. Statistical analysis was performed by using "MedCalc", version 19.1.7. (Ostend, Belgium). Serum levels of TNF-α and IL-6 were significantly higher in PD-patients with 5 or more comorbid diseases. Levels of TNF-α>13.0 pg/ml have a negative effect on the dynamics of prevalence of heart failure (HF) and coronary heart disease (CHD), number of comorbid conditions in CAPD-patients. The proportion of the dead with a level of TNF-α>13.0 pg/ml was by three times higher, and deaths from cardiovascular events are almost by 10 times higher than patients who had a level of TNF-α≤13.0 pg/ml. Serum levels of IL-6>23.4 pg/ml are associated with a significant increase in number of comorbid conditions, prevalence of bacterial infections and overall and infectious mortality. Independent predictors of comorbidity and overall mortality in patients with ESRD who are treated with CAPD are serum levels of TNF-α, IL-6 and albumin. Serum levels of TNF-α and albumin are predictors of fatal cardiovascular events, and serum levels of IL-6 are predictors of fatal infectious events

THE PREDICTORS OF HOSPITALIZATION IN HEMODIALYSIS PATIENTS

Summary. The aim of the present research was to identify predictors of hospitalization hemodialysis (HD) patients. Materials and methods. The study involved 186 HD patients (49,38±0,94 у.) between Jan 2013 and Jan 2014. We studied the evolution of laboratory and treatment parameters, including dry body-weight, ultrafiltration, mean blood pressure, plasma albumin, Hb, absolute lymphocyte count, absolute neutrophil count, neutrophil-to-lymphocyte ratio, “hemoglobin variability ” all patients. The HD patients were divided for 2 groups: I group of outpatients (n=103), II group of hospitalized patients (n=83). Data from 83 hospitalized patients were compared with non-hospitalized patients. Laboratory and treatment parameters were assessed at least 3 months prior to admission. Results. We found that hospitalization was 45,29±4,20 days, frequency of hospitalization 1,46±0,07. The likelihood of frequency and duration a hospitalization increased with patient age (p<0,05). Hospitalizations were preceded by a decrease level albumin, a decline in Hb concentration, a decrease absolute lymphocyte count, increase in the neutrophil-to-lymphocyte ratio, a reduction ultrafiltration. The hozpitalization of patients with “stable hemoglobin ” was significantly lower than in patients with “low of hemoglobin variability”(p<0,005). Conclusions. Patients whose noted these parameters should be monitored, thus, it may be useful to identify risk factors for hospitalization

HEART RATE VARIABILITY IN HEMODIALYSIS PATIENTS

There are a small number of works that have studied heart rhythm variability parameters in patients treated with hemodialysis. Aim. To investigate the peculiarities of heart rhythm variability parameters in patients treated with hemodialysis. Methods. The observational controlled study included 55 patients treated with hemodialysis, aged 24 to 75 years, including 29 men and 26 women. The control group consisted of 20 healthy individuals of comparable age and sex. Heart rhythm variability parameters were investigated in all patients. Results. In the study of heart rhythm variability in patients treated with hemodialysis comparatively with the control group time parameters and most of frequency indexes were decreased. Conclusions. Our study found the diminishment of the total power of neurohumoral regulation in patients treated hemodialysis, as evidenced by the low values SDNN, rNN50, CV

INFLUENCE OF EPOETIN ALFA ON LEVEL OF PROINFLAMMATORY AND ANTIINFLAMMATORY CYTOKINE OF PATIENTS IN MAINTENCE HEMODIALYSIS

Summary. The aim of the present research was to study the influence of еpoetin alfa to the level of pro- and anti-inflammatory cytokines in patients with anemia treated by hemodialysis (HD). Materials and methods: We examined 73patients with anemia treated by hemodialysis (mean age 45,85 ±1,21 years). Patients were divided into 2groups: I group - comparison (n = 32), II group - treatment by epoetin alfa (n = 41). The levels of hemoglobin, C-reactiveprotein, ferritin, albumin, pro-and anti-inflammatory cytokines were determined before and after treatment in patients of both groups. The duration of treatment was 5 months. Results: Epoetin alfa increases Hb levels in patients treated by HD. After epoetin alfa applying reduction of proinflammatory cytokines ( TNF -a, IL -ip, IL -17, IL -18) and increased levels of IL -10 were observed. Conclusions: The clinical efficacy of the epoetin alfa treatment at the moment of completion of treatment was 75.6% (level of Hb > 110 g/L ). Epoetin alfa, improving the level of Hb, reduces the activity of chronic inflammation

Blood vitamins status in patients with stages 2-5 chronic kidney disease

Patients with chronic kidney disease (CKD) are prone to development hypovitaminosis due to dietary constraints, diseases of the gastrointestinal tract, comorbid conditions, etc. Determination of vitamins level in patients with CKD will allow timely correction of their deficiency, prevent the development of hypervitaminosis and reduce oxidative stress. The purpose of the study was to examine the level of vitamins depending on the stage of CKD. Methods. Vitamin D levels (level 25-hydroxyvitamin D), A, E, B12, K, folic acid were determined in 44patients with CKD stages II-V(mean age 54,63 ± 2,63 years, 24 men 55%). According to the study, patients should not have received any drugs or biologically active additives containing vitamins for 3 months. Results. There was no significant difference in the level of studied vitamins in CKD st. II-III. There was a significant decrease in the levels of vitamin K, folic acid, and vitamin D levels with the progression of CKD. Vitamin A levels in CKD st. IV, V compared to CKD st. II were significantly higher. Considering large number drugs containing vitamins and trace elements and wide uncontrolled use in the population, in particular in patients with CKD, it is important to continue to study the levels of vitamins and trace elements in patients at different stages of the CKD, depending on the CKD nosology. Study of efficiency and safety applying vitamins in patients with CKD, particularly in the late stages of CKD, are appropriate. Conclusions. For patients with CKD characteristic of vitamins deficiency (in our study vitamin K, folic acid), but also an increase in their levels (vitamins A and E). Progression of CKD is accompanied by a change in the levels of vitamins. A significant decrease in the level of vitamin K, folic acid, vitamin D was notedfor patients with GFR <30 ml/min/1.73 m2