INFLUENCE OF SECONDARY HYPERPARATHYROIDISM ON THE CALCIFICATION OF HEART VALVES IN PATIENTS WITH CHRONIC KIDNEY DISEASE VD STAGE

The aim of this work was to study the relationship of elevated levels of parathyroid hormone (PTH) with cardiovascular changes (calcification of the heart valves) and to identify possible risk factors of calcification in the group of patients receiving renal replacement therapy. Materials and methods. The study included 96 patients with ESRD: 1-st group receives the treatment of peritoneal dialysis (PD) (45 patients), 2-nd group haemodialysis (HD) (51 patients). In serum determined concentration of calcium, phosphorus, PTH. All patients underwent echocardiographic examination. Results. The prevalence of secondary hyperparathyroidism in PD-patients reached 72%, in HD-patients 83%. Calcification of heart valves in both groups occurred in patients with high PTH level (greater than 400 PG/ml). Patients in both groups were significantly more frequent in the combined mitrale-aortic calcification. Isolated mitral calcification was detected more often aortic. Predictors of progression of calcification of heart valves in patients on PD is the age, in patients on HD - level average BP and the duration of dialysis therapy. Conclusions. Echocardiological data and clinical and laboratory examination of patients with ESRD allowed us to estimate the prevalence and structure of mitrale-aortic calcification and its relationship with secondary hyperparathyroidism

MODERN VISION OF DEVELOPMENT FACTORS OF PROTEIN-ENERGY MALNUTRITION SYNDROME IN PATIENTS, RECEIVING PERITONEAL DIALYSIS

Patients who have end-stage chronic kidney disease (СKD) and who receive substitutive peritoneal dialysis (PD) therapy, often have complication such as protein-energy malnutrition syndrome (PEMS). Important prognostic value is given to nutritional disorders as they increase prior disease development, complicate its correction, influence survival rate of patients of this category. Purpose: to explore prevalence of protein-energy malnutrition syndrome in PD patients and define factors of its development. Materials and methods: 67 PD patients were examined. Evaluation of nutritional status in patients under investigation was made using development of complex methodology that includes 5 specifications – body mass index (BMI), triceps skinfold, arm circumference – biceps, floating albumin and seraalbumin, absolute number of lymphocyte. Results. PEMS was found in 35,8% of patients, 29,8% had mild case and 6% had moderate case with mixed form domination. 26,8% of PD patients had average high or high transport characteristics of abdominal membrane that provided increased protein loss through abdominal membrane on PD. It was determined that with the growth of С-reactive protein (CRP) level nutritional disorders increased. In our research chronic inflammation syndrome was found in 16,3% of cases. Besides, protein loss was growing fast after another dialysis peritonitis. Expressed deficit of daily consumption of protein was registered in 29,2% of patients. Conclusion. Our researches analysis allowed us to define that risk factors of formation of protein metabolism disorders in PD patients are low protein consumption, connection with nutritional deficiency syndrome, system inflammatory reaction, protein loss with dialysis fluid having high transport characteristics of abdominal membrane and repeated dialysis peritonitis

DYSLIPIDEMIA AS A FACTOR FOR PROGRESSION OF RENAL OSTEODYSTROPHY AND CORONARY HEART DISEASE IN PATIENTS WITH CHRONIC KIDNEY DISEASE ON PERITONEAL DIALYSIS

Numerous studies of the last years focused on various links of pathogenesis and factors for progression of coronary heart disease (CHD) and chronic kidney disease (CKD) allowed to find intersection, such as progression of atherosclerosis or phosphorus and calcium and lipid imbalance, which lead to vascular calcareous infiltration, development of renal osteodystrophy and rising of cardiac risks. Purpose of the research: To define indicators of lipid exchange in patients on peritoneal dialysis which can be factors for progression of renal osteodystrophy and ischemic heart disease. Materials and methods. Indicators of lipid exchange, various types of renal osteodystrophy and clinical types of ischemic heart disease in 114 patients receiving peritoneal dialysis therapy in the Regional Clinical Center of Urology and Nephrology of V.I.Shapoval were analysed. Results. Having analysed changes in blood lipid profile of patients on peritoneal dialysis (PD), we found out a reliable growth of high-density lipoproteins (HDL) in a group of patients without signs of ischemic heart disease and in a group of patients having stable angina, whose primary types of renal osteodystrophy were osteoporosis and fibrous ostitis. Reliable differences had also very-low-density lipoproteins (VLDL) which also were the highest in a group of patients having stable angina without signs of cardiac decompensation. The average duration of PD treatment of patients of this group was 12,3 months. Conclusion. The results of the research confirmed that calcareous infiltration of vessels and heart valves on early stages of PD therapy is mainly caused by dyslipidemia and atherosclerotic changes and less by phosphorus and calcium imbalance which importance increases with duration of PD treatment