Качество жизни больных на программном гемодиализе

The outcome of chronic kidney disease (CKD) is frequently development of end-stage kidney failure that requires program hemodialysis (PHD). Increase of the longevity of long-term PHD patients is associated with continuous somatic and psychic stress for the patient, which might adversely affect the quality of life (QoL) of an end-stage CKD patient.Purpose: to determine the influence of age and dialysis duration on the QoL of end-stage CKD patients receiving PHD.Materials and methods. 50 patients receiving PHD (23 men and 27 women), aged 31 to 79 years, were examined. The mean age was 56.72±11.26 years. The PHD duration ranged between 1 month to 20 years, the average figure being 5.26±4.82 years. The control group included 50 healthy subjects of comparable gender and age. The QoL evaluation data were gathered through survey using the Russian version of SF-36 Questionnaire (Short Form Medical Outcomes Study), validated by the Institute of Clinical and Pharmacological Studies (Saint Petersburg) and analysis of case records.Results. As regards the scales of physical health, a decrease of the QoL of PHD patients was found as follows: РF-physical functioning (54.1±25.6 vs. 85.0±21.4), RP-role functioning related to physical condition (38.5±35.4 vs. 74.5±29.7), Pbodily pain (64.7±32.1 vs. 70.5±24.8), GH-general health condition (51.3±15.9 vs. 65.1±21.7). A trend towards inter-group difference was also discovered as regards the scales of vitality (VT) (53.7±19.5 vs. 61.0±19.4), social functioning (SF) (72.5±18.0 vs. 79.5±23.5). Multiple regression analysis established inverse relationship between the patient’s physical health component (PH) and age (rs=-0.317, P<0.05).Conclusion. In PHD patients, the physical health component is the one that suffers most of all, namely: physical functioning, role functioning related to physical condition, pain intensity, and general health condition. The tendency to statistic differences is observed for the scales of vitality and social functioning of the mental health component. Increase of the age and dialysis duration affect adversely the physical health whereas render no influence on the mental health.Зачастую исходом ХБП является развитие терминальной почечной недостаточности, требующей проведения программного гемодиализа (ПГ). Увеличение продолжительности жизни пациентов, находящихся на длительном лечении ПГ, сопряжено с постоянными соматическими и психическими нагрузками для пациента, что может негативно влиять на качество жизни (КЖ) больного терминальной стадией ХБП.Цель исследования: определение влияния возраста и стажа диализа на КЖ больных терминальной ХБП, находящихся на лечении ПГ.Материалы и методы. Обследовали 50 пациентов, получающих лечение ПГ (23 мужчин и 27 женщин), в возрасте от 31 до 79 лет. Средний возраст составил 56,72±11,26 лет. Длительность лечения ПГ колебалась в пределах от 1 месяца до 20 лет, что в среднем составило 5,26±4,82 лет. В группу контроля включили 50 здоровых людей, сопоставимых по полу и возрасту. Сбор данных по оценке КЖ осуществляли путем анкетирования по русскоязычной версии опросника SF-36 (Short Form Medical Outcomes Study), валидизированной «Институтом клинико-фармакологических исследований» (Санкт-Петербург) и анализа историй болезни.Результаты. В сфере физического здоровья выявили снижение КЖ пациентов, находящихся на ПГ, по следующим шкалам: РF-физического функционирования (54,1±25,6 против 85,0±21,4), RP-ролевого функционирования, обусловленное физическим состоянием (38,5±35,4 против 74,5±29,7), P-интенсивности боли (64,7±32,1 против 70,5±24,8), GH-общего состояние здоровья (51,3±15,9 против 65,1±21,7). Тенденцию к межгрупповым различиям также обнаружили по шкалам жизненной активности (VT) (53,7±19,5 против 61,0±19,4), социального функционирования (SF) (72,5±18,0 против 79,5±23,5). По результатам множественного регрессионного анализа выявили обратную зависимость между показателем физического компонента здоровья (PH) и возрастом пациентов (rs=-0,317, p<0,05).Заключение. У больных, находящихся на ПГ, в наибольшей степени страдает физический компонент здоровья, а именно: физическое функционирование, ролевая деятельность, обусловленная физическим состоянием, интенсивность боли и общее состояние здоровья. Тенденция к статистическим различиям отмечается по шкалам жизненной активности и социального функционирования психологического компонента здоровья. Увеличение возраста и стажа диализа отрицательно влияют на физический и не влияют на психологический компоненты здоровья

Острые и хронические дизиммунные полиневропатии в условиях пандемии COVID-19: патогенез, особенности клинической картины, диагностики и терапии (обзор литературы)

Dysimmune polyneuropathies are the etiologically heterogeneous group of diseases with autoimmune damage to the peripheral nervous system. The rarity of these diseases doesn’t exclude the possibility of their development or exacerbation in patients infected with SARS‑CoV‑2, which will require timely differential diagnosis and urgent specific therapy. The article summarizes current information on the mechanisms of development, clinical features, diagnosis and management of acute and chronic dysimmune polyneuropathies in the context of the COVID‑19 pandemic.Дизиммунные полиневропатии представляют собой этиологически гетерогенную группу заболеваний с аутоиммунным поражением периферической нервной системы. Редкость данных заболеваний не исключает возможности их развития или обострения у инфицированных SARS‑CoV‑2 пациентов, что, в свою очередь, потребует проведения своевременной дифференциальной диагностики и неотложной интенсивной и специфической терапии. В статье обобщены актуальные на данный момент сведения, касающиеся механизмов развития, особенностей клинической картины, диагностики и тактики ведения острых и хронических дизиммунных полиневропатий в условиях пандемии COVID‑19

Specific risk factors for cerebrovascular disorders in patients with chronic kidney disease in the pre-dialysis period

Cerebral vascular disorders are one of the leading causes of disability and mortality in patients with chronic kidney disease (CKD). The article presents the currently available data on risk factors (RF) for the development of cerebrovascular disorders in pre-dialysis patients with CKD. Two groups of RF are identified: traditional and non-traditional (specific). Traditional RF, which include arterial hypertension, diabetes mellitus and hypercholesterolemia, independently affect the cerebral vascular bed and get worse against the background of CKD. Specific RF is associated with features of the CKD pathogenesis. It includes increased blood levels of homocysteine, β2-microglobulin, impaired calcium-phosphorus metabolism, accumulation of uremic toxins and toxins of intestinal bacteria, anemia and other factors. In the present review, special attention is paid to specific RF and pathogenetic mechanisms of the development of cerebrovascular disorders in predialysis patients with CKD. Timely detection of cerebral risk factors may lead to the improvement of early diagnosis and prevention of cerebral vascular disorders, optimization of therapy for patients with CKD

Quality of Life of Long-Term Hemodialysis Patients

The outcome of chronic kidney disease (CKD) is frequently development of end-stage kidney failure that requires program hemodialysis (PHD). Increase of the longevity of long-term PHD patients is associated with continuous somatic and psychic stress for the patient, which might adversely affect the quality of life (QoL) of an end-stage CKD patient.Purpose: to determine the influence of age and dialysis duration on the QoL of end-stage CKD patients receiving PHD.Materials and methods. 50 patients receiving PHD (23 men and 27 women), aged 31 to 79 years, were examined. The mean age was 56.72±11.26 years. The PHD duration ranged between 1 month to 20 years, the average figure being 5.26±4.82 years. The control group included 50 healthy subjects of comparable gender and age. The QoL evaluation data were gathered through survey using the Russian version of SF-36 Questionnaire (Short Form Medical Outcomes Study), validated by the Institute of Clinical and Pharmacological Studies (Saint Petersburg) and analysis of case records.Results. As regards the scales of physical health, a decrease of the QoL of PHD patients was found as follows: РF-physical functioning (54.1±25.6 vs. 85.0±21.4), RP-role functioning related to physical condition (38.5±35.4 vs. 74.5±29.7), Pbodily pain (64.7±32.1 vs. 70.5±24.8), GH-general health condition (51.3±15.9 vs. 65.1±21.7). A trend towards inter-group difference was also discovered as regards the scales of vitality (VT) (53.7±19.5 vs. 61.0±19.4), social functioning (SF) (72.5±18.0 vs. 79.5±23.5). Multiple regression analysis established inverse relationship between the patient’s physical health component (PH) and age (rs=-0.317, P<0.05).Conclusion. In PHD patients, the physical health component is the one that suffers most of all, namely: physical functioning, role functioning related to physical condition, pain intensity, and general health condition. The tendency to statistic differences is observed for the scales of vitality and social functioning of the mental health component. Increase of the age and dialysis duration affect adversely the physical health whereas render no influence on the mental health

Cognitive Status and Risk Factors for Cognitive Impairment in Dialysis Patients

The number of dialysis patients is increasing every year and is estimated to be more than 2 million, with an annual increase of 6–12% in dialysis programs. There is a high correlation between cognitive impairment and mortality in dialysis patients, which suggests the relevance of screening cognitive functions in dialysis patients using different neuropsychological scales.Aim of the study was to test the cognitive status and identify cognitive impairment in patients with terminal stage of chronic kidney disease treated using program hemodialysis, as well as to evaluate risk factors for cognitive impairment in this category of patients.Material and methods. 83 patients aged 28 to 78 years (mean age 56.7±13.7 years) were examined. The main group included 53 people who received program hemodialysis, of them 23 men and 30 women. The mean age of patients in this group was 58.3±13.3 years. The control group composed of 30 individuals without kidney diseases, including 13 men and 17 women. The mean age in the control group was 53.6±14.9 years. The MoCA and SLUMS scales were chosen for detecting cognitive impairment and assessment of neuropsychological status. We used mathematical methods of research data processing such as inductive statistics and correlation analysis.Results. Cognitive impairment was found to be significantly more frequent in dialysis patients (75.5–81.1% of cases, P=0.05) compared to those without kidney pathology. The SLUMS scale was shown to be more sensitive than MoCA (P=0.05, CI 95.0%). The risk factors of cognitive impairment in dialysis patients included increased dialysis duration, age (rs=–0.298) and low estimated urea dialysis adequacy index (Kt/V less than 1.2).Conclusion. A high risk of cognitive impairment is common in dialysis patients. For its timely detection,  the screening neuropsychological test are recommended to be used by clinicians. Cognitive impairment, diagnosed by the tests, is an indication for a specialist consultation

Short Duplex Module Coupled to G-Quadruplexes Increases Fluorescence of Synthetic GFP Chromophore Analogues

Aptasensors became popular instruments in bioanalytical chemistry and molecular biology. To increase specificity, perspective signaling elements in aptasensors can be separated into a G-quadruplex (G4) part and a free fluorescent dye that lights up upon binding to the G4 part. However, current systems are limited by relatively low enhancement of fluorescence upon dye binding. Here, we added duplex modules to G4 structures, which supposedly cause the formation of a dye-binding cavity between two modules. Screening of multiple synthetic GFP chromophore analogues and variation of the duplex module resulted in the selection of dyes that light up after complex formation with two-module structures and their RNA analogues by up to 20 times compared to parent G4s. We demonstrated that the short duplex part in TBA25 is preferable for fluorescence light up in comparison to parent TBA15 molecule as well as TBA31 and TBA63 stabilized by longer duplexes. Duplex part of TBA25 may be partially unfolded and has reduced rigidity, which might facilitate optimal dye positioning in the joint between G4 and the duplex. We demonstrated dye enhancement after binding to modified TBA, LTR-III, and Tel23a G4 structures and propose that such architecture of short duplex-G4 signaling elements will enforce the development of improved aptasensors