ПОРІВНЯЛЬНА ОЦІНКА РЕНОПРОТЕКТОРНОГО ВПЛИВУ КОМПЛЕКСНОГО АНТИГІПЕРТЕНЗИВНОГО ЛІКУВАННЯ У ХВОРИХ ІЗ МЕТАБОЛІЧНИМ СИНДРОМОМ ТА ПОСТІНФАРКТНИМ КАРДІОСКЛЕРОЗОМ

Статья посвящена повышению еффективности лечения гипертензивной нефропатии у больных с метаболическим синдромом и постинфарктным кардіосклерозом на основании изучения функционального состояния почек по уровню микроальбумина в моче в зависимости от состояния инсулинорезистентности, и розработки комплексного лечения с использованием небиволола и бисопролола. Выявлено, что увеличение уровня микроальбумина в моче наиболее существенное в условиях спонтанной гиперинсулинемии, что позволяет считать ее неблагоприятным прогностическим признаком инсулинорезистентности, а микроальбуминурию – показателем тяжести течения гипертензивной нефропатии у больных с метаболическим синдромом и постинфарктным кардиосклерозом. Установлено, что небиволол, в отличие от бисопролола, ефективно уменшает уровень микроальбумина в суточной моче, что в целом уменьшает сердечно-сосудистый риск

СТАН ЕЛЕКТРОЛІТНОГО БАЛАНСУ КРОВІ У ПАЦІЄНТІВ ІЗ ХРОНІЧНОЮ ХВОРОБОЮ НИРОК VD СТАДІЇ, ЯКІ ЛІКУЮТЬСЯ ПРОГРАМНИМ ГЕМОДІАЛІЗОМ

The progression of chronic kidney disease (CKD) is characterized by impaired metabolism of blood electrolytes in two forms – hyperelectrolytemia or hypoelectrolytemia. The aim – to assess the balance of biostructural and bioelectrolytic elements of blood P, Ca, K, Na, Mg, Cl in relation to the function of the parathyroid glands in patients with CKD VD stage, who are treated with program hemodialysis. Material and Methods. 30 patients with CKD VD stage were examined. The state of electrolyte balance was assessed by K, Na, Ca, Mg, Cl and biostructural element P in relation to the level of intact parathyroid hormone. Results. Among the examined patients revealed signs of secondary hyperparathyroiditis of varying severity, electrolyte imbalance K, Na, Ca, Mg, Cl and biostructural element P in the blood. Of particular clinical importance is the tendency to form hypercalcemia on the background of hypomagnesemia – predictors of cardiovascular events. Conclusion. In more than 80 % of cases of patients with stage VD chronic kidney disease treated with programmed hemodialysis, the development of electrolyte imbalance K, Na, Ca, Mg, Cl and biostructural element P is typical. The severity of their imbalance is associated with the development of secondary hyperparathyroidism.Прогрессирование хронической болезни почек характеризуется нарушением метаболизма электролитов крови в двух формах – гиперэлектролитемии или гипоэлектролитемии. Цель – оценить состояние баланса биоструктурных и биоэлектролитичных элементов крови Р, Сa, К, Na, Mg, Cl во взаимосвязи с функцией паращитовидных желез у больных хронической болезнью почек VD стадии, которые лечатся программным гемодиализом. Материал и методы. Обследовано 30 больных хронической болезнью почек VD стадии. Состояние электролитного баланса в крови оценивали по показателям K, Na, Ca, Mg, Cl и биоструктурного элемента Р во взаимосвязи с уровнем интактного паратгормона. Результаты. У обследованных больных выявлены признаки вторичного гиперпаратиреоидита различной степени тяжести, дисбаланс электролитов K, Na, Ca, Mg, Cl и биоструктурного элемента Р в крови. Особое клиническое значение имеет тенденция к формированию гиперкальциемии на фоне гипомагниемии – предикторов сердечно-сосудистых событий. Вывод. Для более 80 % больных хронической болезнью почек VD стадии, которые лечатся программным гемодиализом, характерно развитие дисбаланса электролитов K, Na, Ca, Mg, Cl и биоструктурного элемента Р. Тяжесть нарушений их баланса ассоциируется с развитием вторичного гиперпаратиреоидита.Прогресування хронічної хвороби нирок (ХХН) характеризується порушенням метаболізму електролітів крові в двох формах – гіперелектролітемії або гіпоелектролітемії. Мета – оцінити стан балансу біоструктурних та біоелектролітичних елементів крові Р, Сa, К, Na, Mg, Cl у взаємозв’язку із функцією паращитоподібних залоз у хворих на ХХН VD стадії, які лікуються програмним гемодіалізом. Матеріал і методи. Обстежено 30 хворих на ХХН VD стадії. Стан електролітного балансу оцінювали за показниками K, Na, Ca, Mg, Cl та біоструктурного елемента Р у взаємозв’язку з рівнем інтактного паратгормону. Результати. В обстежених хворих виявлено ознаки вторинного гіперпаратиреоїдиту різного ступеня тяжкості, дисбаланс електролітів K, Na, Ca, Mg, Cl та біоструктурного елемента Р у крові. Особливе клінічне значення має тенденція до формування гіперкальціємії на тлі гіпомагніємії – предикторів серцево-судинних подій. Висновок. Для понад 80 % хворих на хронічну хворобу нирок VD стадії, які лікуються програмним гемодіалізом, характерним є розвиток дисбалансу електролітів K, Na, Ca, Mg, Cl та біоструктурного елемента Р. Тяжкість порушень їх балансу асоціюється із розвитком вторинного гіперпаратиреоїдиту

Effect of Systemic Hypertension With Versus Without Left Ventricular Hypertrophy on the Progression of Atrial Fibrillation (from the Euro Heart Survey).

Hypertension is a risk factor for both progression of atrial fibrillation (AF) and development of AF-related complications, that is major adverse cardiac and cerebrovascular events (MACCE). It is unknown whether left ventricular hypertrophy (LVH) as a consequence of hypertension is also a risk factor for both these end points. We aimed to assess this in low-risk AF patients, also assessing gender-related differences. We included 799 patients from the Euro Heart Survey with nonvalvular AF and a baseline echocardiogram. Patients with and without hypertension were included. End points after 1 year were occurrence of AF progression, that is paroxysmal AF becoming persistent and/or permanent AF, and MACCE. Echocardiographic LVH was present in 33% of 379 hypertensive patients. AF progression after 1 year occurred in 10.2% of 373 patients with rhythm follow-up. In hypertensive patients with LVH, AF progression occurred more frequently as compared with hypertensive patients without LVH (23.3% vs 8.8%, p = 0.011). In hypertensive AF patients, LVH was the most important multivariably adjusted determinant of AF progression on multivariable logistic regression (odds ratio 4.84, 95% confidence interval 1.70 to 13.78, p = 0.003). This effect was only seen in male patients (27.5% vs 5.8%, p = 0.002), while in female hypertensive patients, no differences were found in AF progression rates regarding the presence or absence of LVH (15.2% vs 15.0%, p = 0.999). No differences were seen in MACCE for hypertensive patients with and without LVH. In conclusion, in men with hypertension, LVH is associated with AF progression. This association seems to be absent in hypertensive women

Progression From Paroxysmal to Persistent Atrial Fibrillation. Clinical Correlates and Prognosis

Objectives: We investigated clinical correlates of atrial fibrillation (AF) progression and evaluated the prognosis of patients demonstrating AF progression in a large population. Background: Progression of paroxysmal AF to more sustained forms is frequently seen. However, not all patients will progress to persistent AF. Methods: We included 1,219 patients with paroxysmal AF who participated in the Euro Heart Survey on AF and had a known rhythm status at follow-up. Patients who experienced AF progression after 1 year of follow-up were identified. Results: Progression of AF occurred in 178 (15%) patients. Multivariate analysis showed that heart failure, age, previous transient ischemic attack or stroke, chronic obstructive pulmonary disease, and hypertension were the only independent predictors of AF progression. Using the regression coefficient as a benchmark, we calculated the HATCH score. Nearly 50% of the patients with a HATCH score >5 progressed to persistent AF compared with only 6% of the patients with a HATCH score of 0. During follow-up, patients with AF progression were more often admitted to the hospital and had more major adverse cardiovascular events. Conclusions: A substantial number of patients progress to sustained AF within 1 year. The clinical outcome of these patients regarding hospital admissions and major adverse cardiovascular events was worse compared with patients demonstrating no AF progression. Factors known to cause atrial structural remodeling (age and underlying heart disease) were independent predictors of AF progression. The HATCH score may help to identify patients who are likely to progress to sustained forms of AF in the near future. \ua9 2010 American College of Cardiology Foundation

Cardiovascular Risk Reduction with Icosapent Ethyl for Hypertriglyceridemia

BACKGROUND Patients with elevated triglyceride levels are at increased risk for ischemic events. Icosapent ethyl, a highly purified eicosapentaenoic acid ethyl ester, lowers triglyceride levels, but data are needed to determine its effects on ischemic events. METHODS We performed a multicenter, randomized, double-blind, placebo-controlled trial involving patients with established cardiovascular disease or with diabetes and other risk factors, who had been receiving statin therapy and who had a fasting triglyceride level of 135 to 499 mg per deciliter (1.52 to 5.63 mmol per liter) and a low-density lipoprotein cholesterol level of 41 to 100 mg per deciliter (1.06 to 2.59 mmol per liter). The patients were randomly assigned to receive 2 g of icosapent ethyl twice daily (total daily dose, 4 g) or placebo. The primary end point was a composite of cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, coronary revascularization, or unstable angina. The key secondary end point was a composite of cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke. RESULTS A total of 8179 patients were enrolled (70.7% for secondary prevention of cardiovascular events) and were followed for a median of 4.9 years. A primary end-point event occurred in 17.2% of the patients in the icosapent ethyl group, as compared with 22.0% of the patients in the placebo group (hazard ratio, 0.75; 95% confidence interval [CI], 0.68 to 0.83; P<0.001); the corresponding rates of the key secondary end point were 11.2% and 14.8% (hazard ratio, 0.74; 95% CI, 0.65 to 0.83; P<0.001). The rates of additional ischemic end points, as assessed according to a prespecified hierarchical schema, were significantly lower in the icosapent ethyl group than in the placebo group, including the rate of cardiovascular death (4.3% vs. 5.2%; hazard ratio, 0.80; 95% CI, 0.66 to 0.98; P=0.03). A larger percentage of patients in the icosapent ethyl group than in the placebo group were hospitalized for atrial fibrillation or flutter (3.1% vs. 2.1%, P=0.004). Serious bleeding events occurred in 2.7% of the patients in the icosapent ethyl group and in 2.1% in the placebo group (P=0.06). CONCLUSIONS Among patients with elevated triglyceride levels despite the use of statins, the risk of ischemic events, including cardiovascular death, was significantly lower among those who received 2 g of icosapent ethyl twice daily than among those who received placebo. (Funded by Amarin Pharma; REDUCE-IT ClinicalTrials.gov number, NCT01492361

DYNAMICS OF HEART RATE VARIABILITY UNDER THE INFLUENCE OF OMEGA-3 POLYUNSATURATED FATTY ACIDS IN PATENTS WITH ATRIAL FIBRILLATION AND HEART FAILURE SECONDARY TO METABOLIC SYNDROME

The purpose of the research was to assess the state of time-related indicators of heart rate variability (HRV) under the influence of combined treatment including omega-3 polyunsaturated fatty acids (omega-3 PUFAs) in patients with different forms of atrial fibrillation (AF) and heart failure (HF), depending on the presence of insulin resistance.Materials and methods. The study involved 73 patients with New York Heart Association (NYHA) Class I and II HF and AF and metabolic syndrome (MS). Paroxysmal form of AF was noted in 18 persons, persistent form of AF was seen in 11 persons, 44 persons were diagnosed with permanent form of AF; 15 patients developed NYHA class I HF, 58 patients developed NYHA class II HF. In addition to basic antiarrhythmic therapy 25 patients received aspirin (ASA) (Group 1), 23 patients were given omega-3 PUFAs (Group 2) and 25 patienst took ASC + L-arginine (Group 3).The oral glucose-tolerant test (OGTT) with a parallel determination of glucose (oxidase method) and endogenous insulin (EI) (ELISA) in the blood plasma, Holter ECG monitoring (ECG Hm) with assessment of HRV time-related parameters 2 month before and after complex treatment were performed. Control group included 20 practically healthy persons.Results and discussion. The patients with NYHA class I-II AF and HF and insulin resistance developed violation of temporal parameters of HRV with increased sympathetic nervous system tone in terms of SDANN and decrease in the parasympathetic tone levels according to RMSSD and pNN50 parameters. After treatment the HRV parameters changed positively with varying intensity depending on the type of treatment. Patients with reactive (2 hours after glucose load) and spontaneous (in fasting state) hyperinsulinemia showed a reduction in heart rate (HR) by 16.88% (group 1), 23.88% (group 2) and 17.90% (group 3), respectively compared to basal levels (p1 &lt;0.05). Sinus rhythm was restored in 5 (27.77%) patients with paroxysmal AF. Paroxysmal form of AF transformed into persistent AF in 13(72.22%) patients. In patients with persistent and permanent forms normosystolic variant of AF was reached. In patients with NYHA class I heart failure HR did not change significantly (p1&lt;0.1), in patients with NYHA class II HF it declined by almost 20% in groups 2 and 3 (p1&lt;0.05). In patients with hyperinsulinemia RMSSD index tended to increase in group 1 (p1 &lt;0.1), increased by 24.29% and 22.91% in groups 2 and 3, respectively (p1&lt;0.05), in patients with  NYHA class II HF it increased by 1.5 times compared to basal levels (p1&lt;0.05). A similar direction and intensity changes were detected for the pNN50 parameter.The SDNN index decreased in 8 (44.44%) patients with paroxysmal atrial fibrillation (p1&lt;0.05). The SDANN index decreased by 17.21% in 24 (43.63%) patients with persistent and permanent AF (p1&lt;0.05). 31 (56.36%) patients had a tendency to decrease this index compared to the basal level and index in patients belonged to group 1 (p1&lt;0.1, p2&lt;0.1). The time domain parameters SDNN and SDNN index didn’t significantly change compared to basal levels in all the patients (p1&lt;0.1).Conclusions. Violations of temporal parameters of HRV with increased sympathetic nervous system tone in terms of SDANN and decreased parasympathetic nervous system tone level according to RMSSD and pNN50 parameters were noted in patients with AF and insulin resistance. Under the influence of treatment the balance between the units of the autonomic nervous system (ANS) was restored. The increased parasympathetic activity according to RMSSD and pNN50 parameters and reduction of sympathetic activity in terms of SDANN were detected. The effectiveness of treatment including omega-3 PUFAs for patients with AF and insulin resistance was higher compared to monotherapy ASA and ASA + L-arginine.

Influence of Complex Treatment Including Antiplatelet Agents on the Humoral Indicators of Endothelial Dysfunction in Patients with Atrial Fibrillation

Objective of the research was to compare the effect of complex treatment including omega-3 polyunsaturated fatty acids (omega-3 PUFA), antiplatelet monotherapy with acetylsalicylic acid (ASA) and its combination with L-arginine on the activity of systemic inflammation according to the C-reactive protein (C-RP) parameter and the renin-angiotensin-aldosterone system (RAAS) according to aldosterone levels in the blood at patients with atrial fibrillation (AF) depending on the presence or absence of insulin resistance. Material and methods. The study involved 137 patients with AF and with metabolic syndrome (MS). Paroxysmal AF was detected in 35 patients, persistent – in 12 and permanent – in 90 cases. Depending on the treatment patients were divided into 3 groups: group 1 consisted of 44 patients receiving standard therapy and ASA; group 2 included 46 patients receiving standard therapy and omega-3 fatty acids; group 3 – 47 patients treated with standard therapy, ASA and L-arginine. Oral glucose-tolerance test (OGTT) was conducted along with a parallel determination of glucose (oxidase method) and endogenous insulin (EI) (immunoassay) in the blood plasma.  In each group patients with normal levels of EI, reactive and spontaneous hyperinsulinemia (HI) were detected. C-RP and circulating aldosterone levels were determined using ELISA methods. The survey was performed before and after 2 months of complex treatment. Control group comprised 20 healthy individuals of appropriate age. Results and discussion. After treatment the level of HI did not significantly change in all patients (p1&lt;0.1). The significant decrease of aldosterone levels by more than 60% was observed in patients with reactive and spontaneous HI (p1&lt;0.05) and only by a tendency to decrease in patients with normal levels of EI (p1&lt;0.1). Aldosterone levels reduced in patients with reactive and spontaneous HI in paroxysmal and persistent AF, and did not change in the remaining patients. Levels of C-RP in patients with reactive and spontaneous HI under paroxysmal and persistent AF reduced to a greater extent in patients of groups 2. In all patients of group 3 with paroxysmal and persistent AF C-RP levels reached the control. In 43.47% of patients with permanent AF the normalization of the C-RP was noted compared to the levels before treatment. Conclusions. Chronic inflammation parameter C-RP and secondary hyperaldosteronemia levels are humoral markers of endothelial dysfunction under insulin resistance in patients with AF and MS. Inclusion of medications (omega-3 polyunsaturated fatty acids, or aspirin with L-arginine) into basic therapy promotes more intensive reduction of EI, C-RP and aldosterone levels in the blood compared to aspirin alone

Особливості несприятливих гемостатичних чинників перебігу фібриляції передсердь у хворих із метаболічним синдромом залежно від віку

Purpose – determination of coagulation hemostasis parameters depending on age and plasma endogenous insulin (EI) levels in the patients with different forms of atrial fibrillation (AF) and metabolic syndrome (MS). Materials and methods. The study involved 137 patients with paroxysmal, persistent and permanent forms of AF and with MS, including 28 patients – the middle age (group 1); 67 elderly patients (group 2) and 42 old age patients (group 3); 84 patients –with insulin resistance and 53 patients – without insulin resistance. An analysis of coagulation hemostasis plasma parameters was made according to prothrombin index (PtI), fibrinogen, soluble fibrin monomer complexes (SFMC) and D dimer levels by standard methods. Results. It was found that PtI level tends to increase with age. The most significant increase up to 25 % (p&lt;0.05) was in the 3rd group of patients with spontaneous hyperinsulinemia (HI) and with paroxysmal AF. The plasma fibrinogen level tended to increase with age (р&lt;0.1) and was increased by 1,5-2 times under reactive and spontaneous НI compared to the patients without insulin resistance (p&lt;0.05), both in paroxysmal and in permanent forms of AF. Significant increase of SFMC level was detected in all patients, but there was greater extent in patients of the 2nd and 3rd groups with spontaneous HI (p&lt;0.05) and with the permanent form of AF (p&lt;0.05). Increased plasma D-dimer levels appeared typical for 40% of the patients of middle age and almost 50% in elderly and old patients, mainly in spontaneous HI (p&lt;0.05). The presence of D-dimer in plasma was found in 40 %; 42 % and 54 % cases under paroxysmal, persistent and permanent forms of AF, respectively (p&lt;0.05). Conclusions. Patients of older age groups regardless of AF type and under the presence of insulin resistance are characterized by hypercoagulable state formation and that manifested by increased plasma PtI, fibrinogen, SFMC and D-dimer levels compared to patients without insulin resistance.С целью определения показателей коагуляционного гемостаза в зависимости от возраста и уровня эндогенного инсулина (ЭИ) в крови у больных с различными формами фибрилляции предсердий (ФП) и с метаболическим синдромом (МС) обследовано 137 больных с пароксизмальной, персистирующей и перманентной формами ФП и с МС, среди них 28 – среднего возраста (1-ая группа); 67 – пожилого возраста (2-ая группа) и 42 – старческого возраста (3-ья группа); 84 – с инсулинорезистентностью, 53 – без инсулинорезистентности. Проведено анализ состояния системы коагуляционного гемостаза по показателям протромбинового индекса (ПтИ), фибриногена, растворимых фибрин-мономерных комплексов (РФМК) и D-димеров в плазме крови по стандартным методикам. Выявлена тенденция к увеличению ПтИ с возрастом и наибольшее его повышение почти на 25 % (р&lt;0,05) выявлено у больных 3-ей группы со спонтанной гиперинсулинемией (ГИ) и с пароксизмальной ФП. Уровень фибриногена в крови имел тенденцию к увеличению с возрастом (р&lt;0,1) и оказался увеличенным в 1,5-2 раза при реактивной и спонтанной ГИ по сравнению с больными без инсулинорезистентности (р&lt;0,05), как при пароксизмальной, так и при постоянных формах ФП. Достоверное повышение уровня РФМК выявлено у всех больных, однако в большей степени у больных 2-ой и 3-ей группы со спонтанной ГИ (р&lt;0,05) при перманентной форме ФП (р&lt;0,05). Повышение уровня D-димеров в плазме крови оказалось характерным для 40 % больных среднего возраста и почти у 50 % – в пожилом и старческом возрасте, преимущественно при спонтанной ГИ (р&lt;0,05). Наличие D-димеров в крови обнаружено у 40 %; 42 % и 54 % случаях при пароксизмальной, персистирующей и перманентной форме ФП соответственно (р&lt;0,05). Таким образом, больные старших возрастных груп независимо от формы ФП и при наличии инсулинорезистентности характеризируются формированием состояния гиперкоагуляции, что проявляется повышением уровня ПтИ, фибриногена, РФМК и D-димеров в плазме крови по сравнению с больными без инсулинорезистентности.З метою визначення показників коагуляційного гемостазу залежно від віку та рівня ендогенного інсуліну (ЕІ) в крові у хворих із різними формами фібриляції передсердь (ФП) та з метаболічним синдромом (МС) обстежено 137 осіб із пароксизмальною, персистувальною та перманентною формами ФП та з МС, серед них 28 – середнього віку (1-ша група); 67 – літнього віку (2-га група) та 42 – старечого віку (3-тя група); 84 – з інсулінорезистентністю, 53 – без інсулінорезистентності. Проведено аналіз стану системи коагуляційного гемостазу за показниками протромбінового індексу (ПтІ), фібриногену, розчинних фібринмономерних комплексів (РФМК) та D-димерів у плазмі крові за стандартними методиками. Виявлено тенденцію до зростання ПтІ з віком та найбільше його підвищення майже на 25% (р&lt;0,05) у пацієнтів 3-ї групи зі спонтанною гіперінсулінемією (ГІ) та з пароксизмальною ФП. Рівень фібриногену в крові мав тенденцію до зростання з віком (р&lt;0,1) і виявився збільшеним у 1,5-2 рази при реактивній та спонтанній ГІ порівняно з особами без інсулінорезистентності (р&lt;0,05) як при пароксизмальній, так і при постійних формах ФП. Достовірне підвищення рівня РФМК виявлено у всіх пацієнтів, проте в більшій мірі в осіб 2-ї та 3-ї групи при спонтанній ГІ (р&lt;0,05) та перманентній формі ФП (р&lt;0,05). Підвищення рівня D-димерів у плазмі крові виявилося характерним для 40 % осіб середнього віку та майже в 50 % – у літньому та старечому віці, переважно при спонтанній ГІ (р&lt;0,05). Наявність D-димерів у крові виявлено в 40 %; 42 % та 54 % випадків при пароксизмальній, персистувальній та перманентній формі ФПвідповідно (р&lt;0,05). Отже, пацієнти старших вікових груп незалежно від форми ФП та за наявності інсулінорезистентності характеризуються формуванням станугіперкоагуляції, що проявляється підвищенням рівня ПтІ, фібриногену, РФМК та D-димерів у плазмі крові порівняно з пацієнтами без інсулінорезистентності

Non-Heme Iron Panel in Patients with Anemia and Chronic Kidney Disease

The objective of the study: to improve the quality of diagnosis of anemia of renal origin by studying the non-heme iron state in patients with different stages of chronic kidney disease (CKD). Material and methods: the study included 79 patients with CKD (28 – male, 51 – female) 33-72 years old. The patients were divided into two groups: group I included 24 patients without anemia, group II included 55 patients with anemia. Patients of group II were divided into 3 subgroups: 31 patients– with mild degree of anemia (subgroup 1), 18 patients – moderate degree (subgroup 2), 6 patients – severe degree (subgroup 3). The control group consisted of 20 healthy people. A complete hematology panel, urine tests, kidney ultrasound, serum urea and creatinine levels, glomerular filtration rate (GFR) by MDRD were performed. The serum iron levels, total and latent serum iron ability by ferritin and transferrin levels were measured. Results: among patients CKD of II-III stages in 67% of cases and CKD of IV-V stages in 33% of cases were revealed. Anemia of mild degree was revealed in 56% of cases; moderate degree in 33% and severe degree in 11% of cases. It was found that in the case of anemia of renal origin serum creatinine and urea levels increased, and decreased GFR, serum hemoglobin, hematocrit, iron, transferrin, and ferritin levels deceased also. Intensive change of these parameters was the most pronounced in patients with severe anemia. This was confirmed by exiting positive correlations between hemoglobin and serum iron and transferrin levels. Conclusions: iron deficiency in the body is an important branch of the anemia pathogenesis in patients with CKD. For the diagnosis of anemia and its severity degree we should  consider not only hemoglobin levels but the indicators of non-heme iron status in the patients with CKD. Decreasing serum iron, transferrin and ferritin levels determine severity of anemia and CKD. The lowest non-heme iron levels are typical for patients with CKD of IV-V stages and severe anemia