CARRIAGE OF OPPORTUNISTIC MICROORGANISMS AND SURVIVAL OF PATIENTS WITH CHRONIC KIDNEY DISEASE STAGE 5 D

Despite of significant development of dialysis technology, mortality rates of CKD V D stage patients remain unsatisfactorily high. Next to cardiovascular diseases, infections are seems to be as a major causes of morbidity, hospitalization and mortality in this population. Staphylococcus aureus, especially MRSA, infections are a major cause of morbidity and hospitalization in CKD V D stage patients. Preceding MRSA colonization views as a risk factor for subsequent MRSA infections in future. Aim. The aim of this study was to explore the effects of opportunistic pathogens colonization on survival in patients with CKD VD stage. Materials and methods. This prospective cohort, open-label study included 255patients with CKD V D st. (198 HD and 57 PD patients). Patients were randomized into two groups, depending on the MRSA colonization history: first group (n=66) included patients with identified MRSA colonization and the second group (n=189) included patients with colonization of other opportunistic pathogens. The groups were representative according to gender, age, type of kidney affections and renal replacement therapy (RRT) modality. The endpoint was the total number of deaths. All cases, which took place from 01.08.2011 to 01.08.2016 year, were analyzed. The Kaplan-Meier method was perfomed for evaluation of survival.   Results. The analysis allowed to state that during analyzed period in total were 75 deaths: in the first group ofpatients - 32 (48.5%), and in the second - 43 (22.8%) cases; %2= 14,38, p = 0,000078; RR – 2,131, 95% ffl: 1,484-3,060. The survival rate of patients was significantly lower in the first group, irrespective of RRT modality. The 3-years cumulative proportion surviving was 53% and 79% in the first (MRSApositive) and second groups, respectively; p< 0,001. Conclusion. This study demonstrated that MRSA asymptomatic colonization has a significant negative effect on survival in the patient population with CKD VD stag

AGE AND GENDER-SPECIFICS OF CARDIOVASCULAR MORTALITY IN HEMODIALYSIS PATIENTS

Cardiovascular diseases are the leading causes of death in hemodialysis (HD) patients. An analysis of the epidemiological evidence is the basis for the development of the measures and recommendations directed on reducing prevalence of fatal events, including cardiovascular. Aim. The study of cardiovascular mortality in patients who received treatment for renal replacement therapy, based on the demographic and gender characteristics, type of kidney damage and duration of HD treatment. Methods. Cardiovascular mortality causes in 89 patients who received programmed hemodialysis from January 1, 2007 to December 31, 2011 in Kyiv City Scientific and Practical Center of Nephrology and Dialysis were analyzed. Results. Cardiovascular disease was the primary cause of death in the study population (64, 96 %). The annual cardiovascular mortality rate has a significant positive trend in the HD patients. It was ascertained its declining from 10,26% in 2007 to 6,69% in 2011.  About 40% of cardiovascular causes of death occurred during the first 90 days of HD treatment, 73,53% of them were among males. The number of fatality authentically is higher for younger women with non- diabetic renal glomerular lesions and middle-aged patients with diabetes mellitus. CVD, as the cause of death, was significantly more often for males of middle age with the glomerular (diabetic and non-diabetic) diseases and of the elderly - with nonglomerular and non-diabetic glomerular origin. Conclusion. According to the study the series of the regularities of the structure of cardiovascular mortality has been established. The significant association between the sex of the patient and the type of renal disease was identified in each age group

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&gt;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&gt;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&gt;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

COMORBIDITY AND SURVIVAL OF PATIENTS WITH CHRONIC KIDNEY DISEAS STAGE 5 D

Annual expansion of dialysis population, high mortality, considerable expenses on specialized medical care are evoked the medical community to research comorbidities, that undoubtedly has an influence on course of chronic kidney disease VD stage (CKD VD st.) and prognosis. Aim. The aim of this study was to investigate the prevalence and structure of comorbid conditions in patients with CKDVD stage, and determinate the relation between comorbidities and survival rate in dialysis population. Materials and methods. It was studied the prevalence and structure of comorbidities among 204 patients with CKD VD st. (125 on hemodialysis [HD], 51 on peritoneal dialysis [PD], and 28 on hemodiafiltration [HDF]). All recorded concomitant diseases with its incidence data and coand polymorbidity indices were analyzed in consideration of renal replacement therapy (RRT). The survival rates were assessed in according with indices of comorbidity by Kaplan - Mayer methodology. Results. The performed analysis was demonstrated that in almost single patient had no mononosologicalpathology. The numbers of concomitant diseases were 3,55, 3,3 и 3,4 3,3per patient on HD, HDF and PD, respectively, without significant relation with RRT modality. In according with the study results the most common comorbid conditions, irrespective from RRT modality, were anaemia (88%), arterial hypertension (86%), and secondary hyperparathyroidism (40%). The proposed modified index of polymorbidities was revealed as the universal marker of survival rate in patients with CKD VD st. Conclusion. Thus the considerable prevalence of comorbid conditions in population ofpatients with CKD VD st. irrespective of RRT modality has significant negative effect on prognosis

Factors associated with nutritional status in peritoneal dialysis patients

The aim of our study was to examine the relationship between nutritional status (NS) in patients undergoing continuous ambulatory peritoneal dialysis (CAPD) and dialysis-related factors.Methods. 105 patients who were treated by CAPD were included in this observational study. To assess the NS we determined the level of serum albumin, body mass index (BMI) and subjective global assessment (SGA). The study was carried out in two stages. At the first stage of the work PD patients’ nutrition status was examined. For further analysis, the patients were divided into four groups according to the condition of the NS: the first group (n = 54) consisted of patients without disturbance of nutrition, the second (n = 27) with mild nutrition disorders, the third (n = 13) - with an average degree and the fourth (n = 11) with a severe degree of malnutrition. At the second stage of the work specialty of the nutritional status and residual renal function, frequency of PD-peritonitis, transport characteristics of the peritoneum were studied.Results. Nutritional disorders were observed in 54 (51.4 %) patients. A mild malnutrition was diagnosed in 28.7 % of patients, medium and severe in 12,38 % and 10,48% of patients, respectively. Parameters of NS, except BMI, were higher in patients without nutrition disorders (ND) comparing with the patients who had it. RRF was higher in patients without ND; but anuria was observed practically in all patients with severe ND. We receive direct relationship between the level of serum albumin and RRF (r = 0.53; p <0,001), and SGA and RRF (r = 0.52; p <0,001). Number of PD – peritonitis was lower in patients with normal NS and the highest in patients with severe ND. Strong correlation between the level of serum albumin, SGA, and the frequency and duration of peritonitis was established (r = - 0.59; p<0,001 and r = - 0.59; p <0,001 respectively). High transport characteristic of peritoneum was associated with lower degree of serum albumin and SGA (p <0,001). There was no relationship established between SGA, serum albumin, BMI, age, duration of CAPD treatment, gender, and main nosology.Conclusions: Thus, ND were diagnosed in more than 50% of the examined patients. ND were associated with reduce of RRF, frequency and duration of PD-peritonitis, high transport characteristics of the peritoneum. There was no correlation between level of serum albumin, SGA and gender, duration of CAPD, main nosology and age. BMI did not have correlation with any parameters. The received data testify the necessity of constant monitoring of laboratory and functional parameters of the nutrition status

Pneumonia in patients with chronic kidney disease V D stage: pathogenetic aspects of complex therapy and outcomes

Abstract.The aim of our study was to increase the effectiveness of treatment of comorbid pneumonia in patients with CKD VD stage. Materials and Methods. 73 patients with CKD VD st. (59 on HD and 14 on PD) with mild to moderate comorbid pneumonia who received renal replacement therapy (RRT) during 2013-2016 were included in the observational prospective open-label randomized trial. Patients were randomized into two groups: group 1 (n = 42) included patients who in addition to the conventional therapy of pneumonia received medication «Lipin» as a complex therapy; group 2 included patients (n = 31) who received only basic (traditional) therapy. The groups were representative by the main demographic, social and clinical-laboratory findings, severity of pneumonia, duration and modality of RRT. The primary endpoints were death from any cause and episodes of rehospitalization. The overall assessment of the clinical efficacy of the therapy was based on a comparison of the duration of hospitalization, antibiotic therapy, intoxication syndrome, and regression of X-ray changes. Survival in observation groups was determined by the Kaplan-Meier method. Analyzed cases were included to October 31, 2018. The markers of oxidative stress (OS) were determined in 29 patients of group 1 and 14 patients of group 2 before treatment and after 14 days while treatment of  pneumonia was started. Results. The analysis demonstrated that during a 1-year period a 17 (25,76%) episodes of rehospitalization were recorded: 11 causes (35.5%) in group 1 and 6 (14.3%) in group 2 (χ² = 4.486, p = 0.035). In total, 29 deaths were recorded during the study period: 10 (23.8%) cases in group 1, and 19 (61.3%) - in group 2 (χ² = 8.957, p = 0.003, RR - 2.574, 95% CI: 1.400-4.733). The three- and five-year cumulative survival rates were 83% vs. 21% and 59% vs. 21%, in the group 1 and group 2, respectively (p = 0.00003). It was stated that the duration of hospitalization, antibiotic therapy, intoxication syndrome and X-ray regression were significantly lower in group 1 compared with group 2 (p <0.05). The comparative analysis of dynamics in the groups shows that increasing the treatment effectiveness at complex therapy background accompanied by a significant positive dynamics of OS markers (p <0,05). Conclusions Thus, the results of this study demonstrated the effectiveness of complex method of pneumonia treatment in patients with CKD stage 5D including Lipin medication compared traditional therapy. There is a significant difference in patient survival depending on the proposed and generally accepted treatment

NUTRITIONAL DISTURBANCES IN PATIENTS WITH CHRONIC KIDNEY DISEAS STAGE WHO ARE TREATED BY PERITONEAL DIALYSIS AND ITS RELATIONSHIPS WITH HYDRATION STATUS

The aim of the study was to estimate the nutritional status of patients with chronic kidney disease who are treated by CAPD, the prevalence of its disorders according to functional methods. To study the relationship between nutritional status and hydration. Materials and Methods: During the observational one-stage study, 105 patients with CKD 5D stage who were treated by CAPD were included. To assess the NS, serum albumin and body mass index were determined, functional methods were used, namely, SGA and dietary diary analysis. The status of hydration was assessed by clinical examination and bioimpedance analysis. The study was carried out in two stages. At the first, the definition of laboratory and functional indicators of the National Assembly, assessment of the balance of water sectors was carried out. At the second stage, for further analysis, the patients were divided into four groups according to the condition of the NS, determined on the basis of the SGA: the first group (n = 54) consisted of patients without disturbance of nutrition, the second (n = 27) with mild disruption of nutrition, the third (n = 13) — with an average degree, and the fourth (n = 11) - with a severe degree of malnutrition. Results: Weight loss and subcutaneous fat mass for the past 6 months were detected in 43.8% and 37.14% of patients, respectively. Gastrointestinal disorders and loss of muscle mass were detected in 58.1% and 74.3% of patients, respectively. According to the SGA, nutritional disorders were detected in 51 (48.6%) patients. An easy degree of malnutrition was diagnosed in 25.71% of patients, medium and severe — in 12.38% and 10.48% of patients, respectively. For compare of the data obtained from the survey on the composition of water sectors with reference values allows one to assert the presence of hyperhydration in the examined population. A statistically significant difference is achieved by the volume of extracellular fluid, the volume of circulating blood and plasma. These parameters significantly increase depending on the degree of disturbance of the NS (p <0.001). A direct, reliable correlation was obtained between the SGA and serum albumin level (r = 0.74, p <0.0001), BMI (r = 0.55, p <0.0001) and the inverse volume of extracellular fluid (r = -0, 71; p <0.0001). Peripheral edema as a sign of hyperhydration was detected in 31 patients, the significant majority of whom belonged to the third (10 / 37.03% versus 11 / 84.6%, x2 = 7.965, р = 0.005) and the fourth (10/ 37.03 % against 10 /90,9%, yf = 9,098, р = 0,003) to the group. Daily protein intake, also, was significantly lower in patients of the third and fourth groups (p <0.001). Conclusions: Thus, the normal nutritional status was determined in more than 50% of the patients examined. The level of hydration in patients with nutritional disorders is higher than in patients with normal nutritional status. The received data testify to the necessity of constant monitoring of laboratory and functional indices of NS, expediency of routine use of bioimpedance analysis for hydration estimation

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

Рівень пролактину у пацієнтів з ХХН V стадії, які лікуються гемодіалізом

Розповсюдженість гіперпролатинемії у пацієнтів, які лікуються гемодіалізом (ГД), становить 30-65%. Метою нашої роботи було дослідити рівень пролактину (ПЛ) у пацієнтів з хронічною хворобою нирок (ХХН) V стадії, які лікуються ГД. Матеріали та методи. Відкрите проспективне нерандомізоване дослідження за участю 43 пацієнтів з ХХН VД стадії, які лікуються гемодіалізом. Критеріями включення пацієнтів до дослідження були: інформована згода хворого прийняти участь у дослідженні, лікування ГД понад трьох місяців, Кt/V>1,2; судинний доступ АВ-фістула. Критеріями виключення були: відмова хворого від участі у дослідженні, цироз печінки, гострі гепатити В, С, гіпотиреоз, гострий коронарний синдром, гостре порушення мозкового кровообігу, вагітність, пацієнти з злоякісними новоутвореннями; ті хто, системно отримує такі медикаменти, як трициклічні антидепресанти, інгібітори моноамінооксидази, резерпін, метилдопу, похідні фенотіазину, протиблювотні препарати (зокреама метоклопрамід), інгібітори синтезу дофаміну, нейролептики. Всім хворим проводили визначення ПЛ в сироватці крові. Результати. У хворих, які лікуються ГД констатовано підвищений рівень ПЛ у 32 (74%) пацієнтів. Рівень ПЛ сироватки крові у хворих, які лікуються ГД, був вищим порівняно з групою контролю: 47,17 ± 32,4 проти 11,76 ± 4,33нг/мл (р<0,001). Порушення місячного циклу склало 85% у групі жінок з підвищеним рівнем ПЛ проти 20% у жінок з нормальним рівнем ПЛ (р<0,05). У групах жінок та чоловіків з підвищеним рівнем ПЛ достовірно нижчий рівень Нb (р<0,05). Встановлено, що рівень ПЛ мав негативний кореляційний зв'язок з рівнем Нb(r=-0,36; p=0,02) та позитивний кореляційний звʼязок між рівнем ПЛ та СРБ (r=0,32; p=0,03). Висновки. Розповсюдженість гіперпролактинемії в нашому дослідженні склала 74%. Порушення менструального циклу зустрічалося достовірно частіше у жінок з гіперпролактинемією (85% проти 20%). Підвищення концентрації ПЛ має негативний зв'язок з рівнем Нb та позитивний зв'язок з рівнем СРП, що дозволяє припускати причетність ПЛ до процесів хронічного запалення

HOSPITAL MORBIDITYINPATIENTS WITH CHRONICKIDNEYDISEASE STAGE UD

According to opinion of European researchers the expenses, associated with in–patient treatment, constitutes the significant part of health service expenditure in population of patients on renal replacement therapy (RRT). Only in few studies the hospitalization levels were compared for population ofpatients on hemodialysis (HD) and peritoneal dialysis (PD). Aim. The aim of this study was analysis the hospital morbidity pattern in patients with CKD stage 5D on HD and PD. Materials and methods. It was performed the retrospective (for period 01 Jan to 31 Dec 2013) analysis of hospitalization structure and rate for patients, were treated by RRT. All hospitalization admissions were assessed in view of modality and duration of RRT, demographic/gender characteristics, and renal affection type. In 2013 the RRT treatment were provided to 351 patients, including the 296 on HD and 55 on PD. Results. Overall 173 cases of hospitalization were recorded, including 142 (82,08%) primary and 31 (17,92%) readmissions. Irrespective of RRT modality the three most common causes of hospitalization were cardiovascular diseases (CVD), bacterial infections, and anemia. 41 hospitalization was caused by RRT initiation (28 HD and 13 PD), the most of patients aged 45 years and older. The hospitalization rate in PD patients with was significantly higher than in patients on HD: 70,9±6,1% vs. 34,8±2,8%, respectively;p<0,0001. The duration of hospitalization was significantly higher by HD– than PD patients (30,09±17.21 vs. 21.82±10.56, respectively; p=0,0007).   Conclusions. During follow–up, at least one hospitalization had more than 40%patients with CKD stage 5D. In HD patients the most common causes of hospitalization were bacterial infections, CVD and anemia. Anemia, CVD and bacterial infections were the most frequent causes hospitalization in PD patients