Journal Ukrainian Journal of Nephrology and Dialysis-
Published: 4 September 2019
Ukrainian Journal of Nephrology and Dialysis pp 53-61; doi:10.31450/ukrjnd.3(63).2019.08
Abstract:Cardiovascular complications are a leading cause of morbidity and mortality in dialysis patients. Cardiovascular mortality is more than 40% of the total mortality in this cohort of patients. Recently, there has been an increase in publications on the role of uremic toxins, including “middle molecules”, in the development and progression of cardiovascular complications in dialysis patients. Conventional low-flux (LF) hemodialysis well removes small molecular weight uremic toxins not bound with protein. Evidence for the role of "middle molecules" in the development of many complications, including cardiovascular complications, has contributed to the emergence and development of such dialysis therapy methods as high-flux (HF) hemodialysis, hemofiltration (HF) and hemodiafiltration (HDF). Further evolution of membrane technology has led to the development of protein-leaking membranes or super-flux or high cutoff (HCO) membranes. These membranes are capable of removing molecules in excess of the molecular weight of albumin. The use of these membranes is limited because of the risk of hypoalbuminemia. Today, the closest approximation to the natural glomerular membrane is the so-called Middle Cut-Off (MCO) membrane. The use of MSO membranes is implemented in a new method of dialysis therapy - expanded hemodialysis (HDx). The method is defined as a treatment where diffusion and convection are conveniently combined inside a hollow-fibre dialyser equipped with an MCO membrane. A standard hemodialysis machine is used for the HDx. Increased removal of large medium molecules in HDx may lead to an improvement of clinical outcomes, including a decrease of the cardiovascular events incidence, an all-cause and cardiovascular mortality reduction in dialysis patients.
Published: 4 September 2019
Ukrainian Journal of Nephrology and Dialysis pp 22-26; doi:10.31450/ukrjnd.3(63).2019.03
Abstract:Immunosuppressive drugs predispose the kidney transplant recipient to reactivation of сytomegalovirus (CMV) infections. Prophylaxis given to these patients is very important for the prevention of opportunistic CMV infections. The objective of this study was to evaluate the short term and standard-dose valganciclovir prophylaxis for CMV infections in living donor kidney transplantation. Methods. This study is retrospective one. Between April 2014 and April 2019 100 patients after living donor kidney transplantation with results CMV PCR-DNA and prophylactic treatment were studied retrospectively at Medipol University Medical Faculty Hospital Organ Transplantation Department, Istanbul, Turkey. Results.The mean age was 38.3±15.6 years. 68 (68%) patients were males and 32 (32%) patients were females. All patients were treated with 900 mg daily and 90 days valganciclovir prophylaxis. Mean follow-up was 29.1±15 months. There were not detected CMV infections during the follow-up period. Conclusions: Short term and standard-dosevalganciclovir prophylaxis appears to be successful prevention CMV infections in living donor kidney transplantation.
Published: 4 September 2019
Ukrainian Journal of Nephrology and Dialysis pp 27-30; doi:10.31450/ukrjnd.3(63).2019.04
Abstract:HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets) is a severe and rapidly progressing condition that requires distinct diagnostic considerations. The clinical presentation varied within all of the classes, and the only objective means of diagnosis and evaluation of progression of the condition are laboratory tests. HELLP syndrome may result in severe morbidity and mortality to both the mother and fetus. In this case, we reported that a patient with chronic glomerulonephritis was diagnosed with HELLP syndrome.The case was collected in Institute of Nephrology of the National Academy of Medical Sciences, Kyiv, Ukraine.
Published: 20 August 2019
Ukrainian Journal of Nephrology and Dialysis pp 40-46; doi:10.31450/ukrjnd.3(63).2019.06
Abstract:Residual kidney function (RKF) is a powerful indicator of residual renal functional capacity that eliminates uremic toxins and fluid in hemodialysis patients. The purpose of our study was to investigate the influence of hydrating status on residual renal function in patients with CKD 5HD. Methods. A prospective observational study included 60 hemodialysis patients with CKD VD. All patients were examined - taken general and biochemical blood tests, determined the level of urea and creatinine in the daily urine. RKF was evaluated by urine volume, residual KT / V and KRU. Water balance was measured and evaluated using BCM-monitor. Results.During the analysis of BCM data, hyperhydration (OH / ECW above 15%) was revealed in 15 among all patients included in the study, which amounted to 25%. A statistically significant difference between patients who were hyperhydrated and normohydrated was found in relative (OH / ECW) and absolute hydration (OH), ECW, and ultrafiltration rates. Thus, in the group of hyperhydrated patients, the average relative hydration rate was 14.3% lower compared to normohydrated patients (p < 0.001) and absolute hydration by 2.6 l (p < 0.001). In further analysis, no significant difference between two groups was found in the indicators characterizing the RKF, namely, between the level of urine output, KRU, KT / Vren. The level of ultrafiltration in the group with normal hydration is 900 ml lower than that with hyperhydration (p < 0.005). In study the influence of indicators of hydration status such as OH, OH / ECW, TBW, ECW, ICW on RKF indices no reliable correlation of the above mentioned values with diuresis, KRU, KT / Vren (p > 0.05) was found. A positive correlation was found between KRU, diuresis and KT / Vren, indicating that with increasing diuresis the KRU value and KT / Vren increase (p < 0.001). The same relationship was found between diuresis and KT / Vren, p < 0.001. An analysis of the relationship between absolute and relative hydration with dialysis efficacy (eKT / V) revealed that dialysis efficacy decreases with increase of hydratation in CKD 5HD patients (p < 0.05). Conclusions. The results obtained in our study indicate that the indicators of hydration status at baseline do not allow to find out an influence of them on the baseline level of RKF (diuresis, KRU and KT / Vren) in patients with CKD 5HD. Issues of the influence of hydration status on changes in RKF during the observation will be addressed in the following reports.
Published: 4 August 2019
Ukrainian Journal of Nephrology and Dialysis pp 47-52; doi:10.31450/ukrjnd.3(63).2019.07
Abstract:Infections associated with peritoneal dialysis (infection of the catheter, tunnel infection and peritonitis) are the most common complications of this method. Despite significant progress in the methodological approaches to the prevention, diagnosis and treatment of PD associated infections, peritonitis remains the main risk factor for mortality in PD patients (up to 6%) and plays a significant role in more than 1/6 of the deaths associated with non-infectious complications such as cardiovascular and / or cerebrovascular disease. Besides, PD-associated infections are the most common cause of loss of peritoneal function and the patients’ transition to hemodialysis treatment. About 5% of PD patients are converted to hemodialysis treatment in the first year after postponed peritonitis.
Published: 4 August 2019
Ukrainian Journal of Nephrology and Dialysis pp 17-21; doi:10.31450/ukrjnd.3(63).2019.02
Abstract:Kidney transplantation is the treatment of choice for end-stage kidney disease.The double J stent is commonly used in kidney transplantation.The incidence of urologic complications varies between 0.22 % and 30 %. Ureteral strictures and urinary leakage are the most common urological complications after kidney transplantation. Use of the double J stent can decrease urological complications after kidney transplantation. However, the double J stent can increase urinary tract infections, suprapubic pain and urinary incontinence. This study aimed to evaluate the outcomes of the use of double J stent in kidney transplantation. Methods. Between April 2014 and April 2019 130 patients with the use of double J stent were studied retrospectively at Medipol University Medical Faculty Hospital Organ Transplantation Department, Istanbul, Turkey. In these patients, demographic features, clinical features and urologic complications were evaluated. Results. The mean age of the patients was 38.3 ± 15.6 years. 84 (67 %) patients were males and 46 (33 %) were females. Mean follow-up was 29.1 ± 15 months. Mean double J stent removal time was 31.3 ± 2.2 days. During follow-up, there were no ureteral strictures and urinary leakage. Urinary infections were diagnosed in 5 (3.8 %) patients. Conclusions. Use of double J stent appears to be successful to prevent the urological complications in kidney transplantation.
Published: 14 July 2019
Ukrainian Journal of Nephrology and Dialysis pp 31-39; doi:10.31450/ukrjnd.3(63).2019.05
Abstract:The importance of the problem of acute kidney injury in children is due to the high risk of developing chronic kidney disease as a consequence. Lysosomal enzymes of β-galactosidase (GAL) and N-acetyl-β-D-hexozoaminidase (NAG) in urine are considered to be informative markers of renal parenchyma damage. The objective of this study - to determine the activity of lysosomal enzymes in urine as markers of progression of interstitial nephritis in children after acute kidney injury. Methods. 41 children were examined after acute kidney injury, achievement of self-diuresis and improvement. Group I included 22 patients with a disease period of up to 2 years after acute kidney injury, group II - 19 patients with a disease period of 2 years or more. The control (reference) group consisted of 28 children who were conditionally healthy, without kidney disease, as well as without acute diseases and severe metabolic disorders and anatomical defects. Results. NAG and GAL activity were found to exceed 8 and 3 times parameters in the reference group of healthy children, respectively, in patients who had acute kidney injury during the year (p
Published: 13 June 2019
Ukrainian Journal of Nephrology and Dialysis pp 3-16; doi:10.31450/ukrjnd.3(63).2019.01
Abstract:Institute of Nephrology of the AMS of Ukraine was established in 2001. Today the Institute constitutesserves as national center in nephrology field. Scientific achievements of the institute staff are known both in Ukraine and abroad scientific achievements of the institute. The aim. Analysis of results and forecast of activities of SI "Institute of Nephrology of the NAMS of Ukraine".
Published: 6 June 2019
Ukrainian Journal of Nephrology and Dialysis pp 18-23; doi:10.31450/ukrjnd.2(62).2019.03
Abstract:Перкутанна нефролітотомія (ПНЛТ) є основним методом лікування пацієнтів з сечокамʼяною хворобою. Сьогодні стандартне виконання ПНЛТ передбачає завершення операції шляхом встановлення черезшкірного нефростомного дренажу. Бездренажна ПНЛТ асоційована зі зменшенням післяопераційного болю та часу госпіталізації. Незважаючи на переваги, бездренажна ПНЛТ збільшує ризик залишення фрагментів конкременту, що вимагає застосування додаткових процедур та подовження часу госпіталізації. Метою дослідження було порівняти ефективність і безпечність бездренажної та стандартної ПНЛТ із застосуванням нефростомного дренажу. Методи. Проспективне порівняльне дослідження, проведене у відділенні урології Safeer Al-Imam Al-Hussein у Карбалі з січня 2013 року по 31 грудня 2017 року. 1434 пацієнтів з нирковими конкрементами, яким виконано ПНЛТ були розподілені залежно від застосованого хірургічного лікування: 1-й групі пацієнтів (n = 882) виконано ПНЛТ із застосуванням дренажу, у 2-й групі (n = 552) застосовувалась бездренажна ПНЛТ. Результати. Бездренажна ПНЛТ частіше застосовувалась у жінок молодого віку та у хворих з конкрементами лівої нирки з простим доступом, тоді як дренаж частіше використовувався за наявності конкременту правої нирки (р = 0,006). Післяопераційно, бездренажна ПНЛТ була статистично значущо асоційована з низькою частотою залишкових фрагментів конкременту (p = 0,005), кровотеч (p = 0,04) і сепсису (p = 0,01) порівняно із стандартною процедурою. Висновки. Бездренажний варіант ПНЛТ асоціюється з низькою частотою залишкових фрагментів каменів, післяопераційних кровотеч та сепсису, що обґрунтовує ефективність і безпечність його застосування.
Published: 4 June 2019
Ukrainian Journal of Nephrology and Dialysis pp 33-40; doi:10.31450/ukrjnd.2(62).2019.05
Abstract:The objective of the work was to study the survival peculiarities ofend-stage renal disease patients treated with continuous ambulatory peritoneal dialysis (CAPD) depending on the nutritional status and informative markers associated with it. Methods. 105 ESRD patients who received CAPD treatment during 2012 - 2017 years at the Kyiv Scientific and Practical Center of Nephrology and Dialysis, which is the clinical base of the State Institution "Institute of Nephrology National Academy of Medical Sciences of Ukraine" were included in the cohort prospective open study. The survival analysis was carried out both in the studied population as a whole and in groups depending on the nutritional status (NS) indicators defined basing on the calculation of the subjective global assessment (SGA) points: the first group (n = 51) consisted of patients without malnutrition, the second group (n = 30) - patients with a mild degree of malnutrition, the third group (n = 13) - patients with a moderate degree of malnutrition, and the fourth group (n = 11) - patients with a severe degree of malnutrition. The survival analysis was conducted both in the groups in compliance with NS, and depending on the informational markers associated with NS, in particular, albumin, body mass index (BMI), residual renal function (RRF). Survival were calculated using the Kaplan-Meier method, and the difference between survival rates was analyzed using the log-rank test and χ². The starting date of peritoneal dialysis treatment was considered as the starting point of the monitoring. The difference was considered to be accurate at p 24 kg/m2 was apparently higher than those with an indicatorBMI ≤ 24 kg/m2, and it was in 1 and 3 years 94% vs 86% and 79% vs 47%, respectively (p = 0.00321, log-rank test). Veritable differences have been registered in the cumulative frequencies of survivors depending on RRF value: the survival rate was significantly higher among patients with RRF ≥ 5 ml/min/1.73 m² and significantly lower among patients with RRF
Published: 3 June 2019
Ukrainian Journal of Nephrology and Dialysis pp 3-9; doi:10.31450/ukrjnd.2(62).2019.01
Abstract:The aim of the work was to conduct a rating of nephrological services in the regions of Ukraine by using the method of complex statistical coefficients. Methods. Evaluation of nephrological services in the regions of Ukraine was performed via using indicators of the structure, health care resources, quality and efficiency of renal medical care of patients with chronic kidney disease and patients with acute kidney injury. Results. The place of each province in national rating of state of renal medical care was identified. Conclusions. Dramatic differences in the specialized nephrological care between the regions of Ukraine are primarily due, in our opinion, to the understanding of its medical and social importance and, hence, the funding level.
Published: 1 June 2019
Ukrainian Journal of Nephrology and Dialysis pp 62-71; doi:10.31450/ukrjnd.3(63).2019.09
Abstract:Resistance to common groups of antibiotics has been increasing in the treatment of urinary tract infections worldwide. In the United States, CDC has estimated that more thаn 2 million infections and 23,000 deaths are due to antibiotic resistance each year. In Europe, an еstimated 25,000 deaths are attributable to antibiotic-rеsistant infections. By 2050, it is estimated that antibiotic resistance will cause 10 million deaths every year.At the EU/EEA level, more than half (58.2%) of the E. coli isolates reported to EARS-Net for 2017 were resistant to at least one of the antimicrobial groups under regular surveillance, i.e. aminopenicillins, fluoroquinolones, third-generation cephalosporins, aminoglycosides and carbapenems. A majority (87.4%) of the third-generation cephalosporin-resistant E. coli isolates from 2017 were extended-spectrum beta-lactamase (ESBL)-positive. Use of broad-spectrum antimicrobials is a known risk factor for colonization and spread of resistant Enterobacteriaceae, including E. coli. The high levels of ESBLs and increasing resistance to key antimicrobial groups might also lead to an increased consumption of carbapenems, which in turn can increase the selection pressure and facilitated the spread of carbapenem-resistant Enterobacteriaceae. According to annual reports of CDC, WHO, EARS-Net and others,estimate that 30 percent of all antibiotics prescribed in outpatient clinics and 40 percent of all antibiotics prescribed in inpatient clinics were unnecessary. Improving the way we use antibiotics, often referred to as «antibiotic stewardship», is part of the National Action Plan. Appropriate antibiotic use means using the right antibiotic, at theright dose, for the right duration, and at the right time. The article reflects the recommendations of the European Association of Urology 2019 on the management and treatment of urinary tract infections in accordance with the principles of Antimicrobial Stewardship Program.
Published: 10 April 2019
Ukrainian Journal of Nephrology and Dialysis pp 41-47; doi:10.31450/ukrjnd.2(62).2019.06
Abstract:Protein-energy wasting as a manifestation of nutritional disorders is one of the central complications in chronic kidney disease (CKD) and largely determines quality and life expectancy. Both decrease in nutritional status and systemic inflammation are independent predictors of general and cardiovascular mortality. Mutual stimulation of these factors determines the search for new directions for the treatment of patients with CKD. The aim of the research was to study the state of systemic inflammation and malnutrition in CKD by assessing the level of interleukin 1β (IL-1β), interleukin 6 (IL-6), interleukin 8 (IL-8) and C-reactive protein (CRP) and serum albumin and to study the effectiveness of therapy with levocarnitine and a solution of a mixture of ketanalogs of irreplaceable and substitute amino acids for parenteral administration in CKD. Results. The level of markers of inflammation IL-1β, IL-6, IL-8 and CRP progressively increased in parallel with the development of renal failure. The level of albuminemia decreased from the I to the V stage of the CKD, in which among patients with glomerular filtration rate 15 - 45 ml/(min · 1.17 m2) in 14% there was a malnutrition of a mild degree; whereas, at CKD of the V stage, malnutrition of a mild degree was in 16% of patients, moderate malnutrition was detected in 10% of the subjects, and 5% suffered from severe malnutrition. After standard therapy the least effect was observed. A more significant decrease in the level of proinflammatory cytokines and CRP was observed with the additional acquisition of levocarnitine. An even better effect was observed in the group of patients receiving Nefrotect. The most significant level of inflammation markers decrease was seen in the group receiving combined Nephrotect therapy with levocarnitine Nefrotect, where the concentration of proinflammatory interleukins decreased more than threefold compared with baseline. The level of albuminemia reached the highest level with combined therapy, compared with standard therapy. Conclusions. Nutritional status of patients with CKD decreases progressively in the fall of kidney function, reaching the level of mild malnutrition at CKD stage III and the severe degree of malnutrition at CKD stage V. With the progression of renal failure, activation of the systemic inflammation, in particular, the increase of the level of circulating in the blood of interleukin 1β, interleukin 6, interleukin 8 and CRP was seen. The efficacy of treatment of systemic inflammation and protein-energy insufficiency by levocarnitine and a solution of a mixture of ketonalogs ofirreplaceable and substitute aminoacids in the cohort of patients with CKD of the І-V stages is proved. This combined therapy significantly lowered the level of interleukin 1β, interleukin 6, interleukin 8, and CRP, as well as elevated serum albumin levels in patients with CKD.
Published: 4 April 2019
Ukrainian Journal of Nephrology and Dialysis pp 24-32; doi:10.31450/ukrjnd.2(62).2019.04
Abstract:Understanding of changes in water compartments during hemodialysis (HD) is an important part of ensuring the effectiveness of the procedure and minimizing both intra- and post-dialysis complications. The purpose of our study was to investigate the direction of changes in water sectors in patients with CKD 5D with preserved residual kidney function (RKF) and without RKF. Methods. Prospective observational study enrolled 88 hemodialysis (HD) patients. All patients performed laboratory examinations and measurements of water balance using the BCM monitor before HD, hourly after the start, and 30 minutes after the end of the session. Depending on the presence of residual kidney function, patients were divided into two groups. The first group with RKF included 52 patients, the second - without RKF - 36. Results. Analysis of water balance parameters allowed to conclude that 26 patients (26.13%) were hyperhydrated (OH/ECW above 15%), including 13 (36,11%) in the group without RKF and 10 (19,2%) - in the group with the preserved RKF. There was no statistically significant difference in the groups. When comparing baseline values between groups of patients, it was found that in the group with preserved RKF the albumin level was significantly higher at 8.94% (p
Published: 4 March 2019
Ukrainian Journal of Nephrology and Dialysis pp 48-53; doi:10.31450/ukrjnd.2(62).2019.07
Abstract:The Fabry Disease in young white man with End Stage Renal Disease was reported. Diagnosis was detected at stage of hemodialysis treatment despite sings which admitted as clinical criteria were found at childhood but did not identify during 20 years due limited awareness of medical community about lysosomal disorders.
Published: 22 February 2019
Ukrainian Journal of Nephrology and Dialysis pp 13-19; doi:10.31450/ukrjnd.1(61).2019.02
Abstract:The aim of the study was to assess a serum level of vascular endothelial growth factor (VEGF) in type 2 diabetic patients depending on kidney function. Methods: we examined 66 type 2 diabetic patients and 20 healthy control subjects. Depending on the presence of albuminuria and glomerular filtration rate (GFR) level, patients with diabetes mellitus (DM) were divided into the following groups: group I - patients with type 2 DM without signs of nephropathy – normal GFR without albuminuria (n = 26); group ІІ - patients with type 2 DM with normal GFR and albuminuria (n = 22); group III - patients with type 2 DM with reduced GFR and albuminuria (n = 18). ІV group - patients with acute coronary syndrome (n = 26). The concentration of the VEGF was determined by enzyme-linked immunosorbent assay. The glomerular filtration rate (GFR) was calculated using the CKD EPI formula (KDIGO 2012). Results: serum VEGF level in patients with diabetic nephropathy (DN) was significantly increased depending on kidney function. VEGF positively correlated with urine albumin and serum creatinine levels and the negative correlation with GFR was found. These findings prove the undeniable role of kidneys in the development of renocardial syndrome in patients with DN. VEGF levels positively correlated with glycosylated hemoglobin and total cholesterol, indicating an unconditional dependence of endothelial dysfunction on lipid and glucose metabolism disorders. Conclusions: Increased levels of VEGF in type 2 diabetic patients without clinical signs of kidney damage may indicate the development of subclinical renal dysfunction. Blood VEGF in patients with DN may be an integral marker of endothelial dysfunction and pathological angiogenesis. Our findings suggest that determination of serum VEGF level in patients with DN may have practical use as an early predictor of cardiac disruption, estimation of the prognosis, as well as improvement of cardionephroprotective strategy.
Published: 20 February 2019
Ukrainian Journal of Nephrology and Dialysis pp 53-59; doi:10.31450/ukrjnd.1(61).2019.07
Abstract:According to current presentations, primary AL-amyloidosis (AL-A) and multiple myeloma, associated and not associated with AL-A, are considered as a part of uniform β-lymphocytic dislocation that is characterized by proliferation of abnormal clone of plasma or β-cells in the bone marrow with excess production of monoclonal immunoglobulins. Objective: to describe our own observations of patients with AL-A, which is an example of complexity of the disease diagnostics, due to the polymorphism of clinical picture and need for immunological verification. It was presented 2 cases of late AL-A diagnostics. Amyloid depositing in different organs determined the diversity of clinical manifestations. AL-A had a consistently progressive character with the gradual involvement of various organs and systems. Results: case 1 demonstrated AL-A with damage of kidneys, heart, liver, spleen, lungs, pleura and subsequent development of ischemic stroke. In the second case AL-amyloidosis with damage of heart, kidneys, lungs, tongue and skin was diagnosed. The severity of the patient's condition was due to severe nephrotic syndrome. AL-A is a serious disease that leads to a lethal end if treatment is not timely. Our observations demonstrate the complexity of AL-A diagnostics, which requires the collaboration of doctors of various profiles. Modern morphological diagnostics of amyloidosis involves not only detection but also mandatory amyloid typing, which determines further therapeutic tactics. Diagnostics of AL-A diagnosis should be based on the morphological study results. The final diagnosis of amyloidosis is established after congolic masses detecting. Biopsy of the affected organ is the most effective diagnostic method. When there is a nephrotic syndrome, kidney biopsy is most appropriate, because amyloid will be detected in 80% of AL-A. The most effective method for AL-A typing is an immunohistological study using the immunoglobulin light chains antisera.
Published: 18 February 2019
Ukrainian Journal of Nephrology and Dialysis pp 39-44; doi:10.31450/ukrjnd.1(61).2019.05
Abstract:The formation in β-structured protein aggregates in tissues and fluids of the body is one of the most dangerouse complications of various diseases. The most famous of them are amyloidoses, but they such deposits are observed at other, much more widespread, diseases. The generally accepted approach to amyloids’detectionis based on high-specific coloring by Congo Red dye. However, the Abbe's diffraction limit excludes the seeing of the objects smaller than 0.61 wavelengths (about 240 nm). Such nanoscale formations are capable to disrup the functioning of surrounding tissues, to causethe complications and recurrences of the disease, and to pass through biological barriers with the following accumulation in body’s fluids. It’s likely that these conditions are the cause of the urinary congophilia, that is associated with preeclampsia at pregnancy and chronic kidney disease. Nor the less suspicious object is the Bens-Jones protein that appears in the urine at multiple myeloma and some other diseases, which are in more or less extent,are related to the disturbance of protein metabolism. The purpose of this study was to clarify the aggregate state of the Bens-Jones protein as a possible β-structured supramolecular associate. Methods.The subject of the study was the freshly received urine from a patient with multiple myeloma. The presence of the Bens-Jones protein was checked by thermopacification of the acidified sample. For control, the urine was used by a healthy person with the addition of certain amounts of human serum albumin ("Reanal", Hungary) with a concentration of 0, 0.01, 0.1 and 1%. Result. The obtained data testify to the appropriateness of such a point of view and create preresquites for the expanding of diagnostic possibilities. Conclusions.The results obtained during the study testify to the peculiarity of the structure of the Bens-Jones protein, which is nano-sized beta-structured supramolecular
Published: 15 February 2019
Ukrainian Journal of Nephrology and Dialysis pp 20-28; doi:10.31450/ukrjnd.1(61).2019.03
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
Published: 13 February 2019
Ukrainian Journal of Nephrology and Dialysis pp 3-12; doi:10.31450/ukrjnd.1(61).2019.01
Abstract:Chronic kidney disease (CKD) is a global public health problem, with cardiovascular disease being the major cause of mortality in these patients. CKD is associated with elevated risks of all-cause mortality and other adverse outcomes. This review is highlighting the consistency of the evidence about the hazards that are associated with CKD. The challenge that clinicians now face is to search for CKD, to manage it aggressively, to evaluate novel means of detecting CKD and to expand the therapeutic strategies for patients with CKD. The evidence base for informing effective kidney care is limited, and the translation of existing knowledge to routine clinical care is slow. Innovative approaches are described – patient-oriented care, complex care individualization, early screening for cognitive disorders, anxiety, renal education including education aids & e-Kidney application, teletechnology approach and CKD-self-testing in rural area, novel therapeutic targets for innovative CKD-oriented drugs, etc. Trials with the aim of re-purposing of generic therapeutics should be prioritized if sufficient scientific evidence is available. Furthermore, strategies used to extend patent life of drugs, but without investment to assess re-purposing, should be discouraged. Finally, if the above goals are achieved, new therapies will certainly become available to stop, slow, or reverse CKD. These therapies should be made accessible to populations around the globe.
Published: 8 February 2019
Ukrainian Journal of Nephrology and Dialysis pp 45-52; doi:10.31450/ukrjnd.1(61).2019.06
Abstract:The aim of our study was to evaluate the quality of life (QoL) in peritoneal dialysis (PD) patients and its relationship with nutritional disorders. Methods. 52 PD patients were included in the observational cross-sectional study. The QoL was conducted using a SF-36 quality of life assessment questionnaire. Moreover, the PD patients’ nutrition status (NS) was examined. For further analysis, the patients were divided into four groups according to the condition of the NS: the first group (n = 22) consisted of patients without nutrition disturbance, the second group (n =13) included the patients with mild nutrition disorders, the third group (n = 10) consisted the patients with an average degree of the NS, and the fourth one (n = 7) envolved the patients with a severe degree of malnutrition. A comparative evaluation of QoL among the PD patients with different nutrition disorders was performed. Results. During the analysis of indicators QoL we receive the following results: all patients were dissatisfied with the general state of health, the lowest of the indicators was the burden of the disease. The physical total component was lower than the mental. According to the analysis of NS parameters, nutritional disorders were observed in 57.6 % patients. Also according to the results, it follows that nutritional disorders negatively affect the QoL of the PD patients. Moreover, a direct strong correlation between the serum albumin level and the overall QoL score was obtained (r = 0.95; p < 0.001). In addition, the strong direct correlation between a body mass index (BMI) and overall QoL (r = 0.92; p < 0.001) and subjective global assessment (SGA) and overall QoL (r = 0.85; p < 0.001) were observed. Conclusions: According to the results of the study, it was found that PD patients' QoL is dissatisfied. It was confirmed that nutritional disorders affect bad on the QoL of patients with almost all parameters. The overall QoL was significantly associated with serum albumin levels, BMI and SGA.
Published: 4 February 2019
Ukrainian Journal of Nephrology and Dialysis pp 29-38; doi:10.31450/ukrjnd.1(61).2019.04
Abstract:We hypothesized that the use of antihypertensive medications in patients treated by hemodialysis (HD) may interfere with the activity of erythropoietin and leads to an increase in the dose of erythropoiesis stimulating agents (ESAs). The aim of our study was to analyze the impact of antihypertensive medications on the effectiveness of anemia treatment. Methods. We conducted a multicenter retrospective observational study. The archival medical data from 379 patients treated by HD or hemodiafiltration (HDF) were used. The medical records of 142 patients were excluded from the study. The study group consisted of 237 patients: 108 (45.6%) women and 129 (54.4%) men, with an average age of 54 [41-62.5] years. Results. The analysis of the mean hemoglobin (Hb) stratified by the administration of antihypertensive medications in the dynamics of dialysis treatment demonstrated a significant impact of angiotensin-converting enzyme (ACE) inhibitors (F = 3.97; p = 0.048) and amlodipine (F = 6.9; p = 0.01) on the effectiveness of anemia correction. The significant effect of amlodipine on the need to increase the dosage of iron-containing medications (OR = 3.9; 95% CI (1.27-12.06), p = 0.002; RR = 1.9 95% CI (1.27-2.9) and continuous erythropoietin receptor activator (CERA) (OR = 5.2, 95% CI (1.2-24.4), p = 0.03; RR = 1.3 95% CI (1, 08-1.6), p = 0.006) weas showed by logistic regression analysis. The increased risk of failure to achieve of the target Hb level in HD patients received amlodipine was confirmed by Cox regression model (HR = 2.7 (95% CI 1.5-4.7)). Conclusions: The results of our study demonstrated a significant increase in the frequency of appointment and amount of anti-anemia therapy in HD patients when amlodipine is co-administered. Follow-up studies to determine the effect of amlodipine mechanism for anemia will avoid unreasonable prescriptions for the treatment of НD patients. Conflict of interest statement: the authors declared no competing interests.
Published: 3 February 2019
Ukrainian Journal of Nephrology and Dialysis pp 10-17; doi:10.31450/ukrjnd.2(62).2019.02
Abstract:The present study was undertaken to investigate the association of hydration status measured by bioimpedance analysis with oxidative stress biomarkers and peritoneal dialysis (PD) adequacy. Methods. It was a case-control study involved 85 PD patients from 2 dialysis centers in Ukraine. Among the examined patients, there were 56/85 (65.9%) men and 29/85 (34.1%) women. All patients had been undergoing PD for more than 3 months (median was 25.4 [14.0-49.5] months). Average age was 48.8 ± 12.5 years. Fluid compartments [extracellular water (ECW) and overhydration index (OH)] were measured using Multifrequency bio-impedance (BCM®, Fresenius Medical Care, Germany). Overhydration was defined as OH/ECW> 15%. Malondialdehyde concentration in serum (MDAs) and erythrocytes (MDAe) was defined as an indicator of lipid peroxidation. Such parameters as the concentration of ceruloplasmin (CP), transferrin (TR) and sulfhydryl groups (SH-groups) in the blood and total peroxidase activity in erythrocyte (TPAe) were studied as the indicators of antioxidant system. Moreover, to determine the intraperitoneal oxidative stress induction, we studied MDA and TPO in PD effluent. Results. Among 85 PD participants, there were 38(44.7%) patients in normohydration range and 47 (55.3%) overhydrated pаtients according to the OH/ECW ratio. There were a significant increase in serum and PD effluent MDA (p = 0.01 and p = 0.001, respectively) in overhydrated PD patients whereas the concentrations of serum CP and TPA in PD effluent were significantly lower compared with normohydrated patients (p = 0.008 and p = 0.04, respectively). In addition, ECW had an inverse correlation with SH-groups (r = -0.37; p = 0.003) and MDAs (r = -0.48; p = 0.004). An odds ratio of PD inadequacy was 3.6 times higher among overhydrated patients than in normovolemic one: OR = 3.6 (95% CI 1.3-10.3; p = 0.01). Conclusions. Extracellular fluid overload promotes intraperitoneal and systemic oxidative stress which could be one of the pathway explanations of technique survival failure and cardiovascular mortality in overhydrated PD patients.
Published: 9 January 2019
Ukrainian Journal of Nephrology and Dialysis pp 54-67; doi:10.31450/ukrjnd.2(62).2019.08
Abstract:Mechanisms mediating oxalate-induced alterations in renal have attracted the attention of scientists in recent years.Various mechanisms have been proposed to explain crystal retention. The present review assesses the biochemical mechanisms of oxalate-induced alterations and diagnostically significant markers of organ damage caused by oxalate. The article focuses on the modern data of molecular-biochemical aspects of the formation of oxalate-induced diseases.
Published: 26 December 2018
Ukrainian Journal of Nephrology and Dialysis pp 19-27; doi:10.31450/ukrjnd.4(60).2018.03
Abstract: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
Published: 26 December 2018
Ukrainian Journal of Nephrology and Dialysis pp 11-18; doi:10.31450/ukrjnd.4(60).2018.02
Abstract:Studies devoted to the role of human leucocyte antigens (HLA) in pathogenesis of chronic kidney disease (CKD) have demonstrated the associative links of the HLA antigens, which stipulate the relative and attributive risks of some autoimmune diseases, with immune disorder and a high production of pro-inflammatory cytokines. The aim of our study was to determine the peculiarities of phenotypes of CKD patients according to the distribution of HLA-A, B and DR antigens and to conduct their comparative analysis in patients with pyelonephritis (PN) and glomerulonephritis (GN). Methods: The distribution of HLA-A, B, DR antigens in 384 CKD patients (120 with PN and 264 with GN) was analyzed. HLA antigens were defined using a standard microlymphocytotoxic test on the Terasakiґs planchette with special panels of anti-HLA serums (20 antigens of locus A, 31 – B and 9 – DR). The control group consisted of 350 healthy donors. The HLA antigen frequencies in normal and diseased subjects were compared taking each antigen separately, using χ2 test. The etiologic fraction (attributive risk s > 0,1) was counted using the formula: s = x - y/I- y, where x is frequency of antigen in patients and y is frequency in healthy. The s reading was considered reliable when it exceeded 0.1. Results. The causal role (σ > 0,1) was determined for А10, А11; В14, В16 for PN; antigens-protectors - А2, В21, В35, В40. For CGN, NS the relative risk is high (RR > 2) at the presence of HLA-A23, А24, А28; B8, В38, В41, В44; DR1, DR4, DRw52 in phenotype, the causal role in etiopathology (σ>0.1) is indicated for A24,А28; B8; DR1, DR4, DRw52; the disease protectors are B12 and B16. Conclusion. Conclusion. The features of the HLA-phenotype of patients with pyelo- and glomerulonephritis were shown. It allowed to establish the interconnectedness of the antigens of the histocompatibility complex with the risk of kidney diseases developing, which could help to personificate of the treatment and predicte of the course of the disease.
Published: 26 December 2018
Ukrainian Journal of Nephrology and Dialysis pp 35-39; doi:10.31450/ukrjnd.4(60).2018.05
Abstract:The aim of our work was to study the level of citrulline in serum as a biochemical marker of the functional state of the kidneys in patients with cardiovascular pathologies. Methods. The study included 134 patients aged 41-68 years, of which 40 patients with stage II arterial hypertension (AG-II) and 62 patients with chronic heart failure (AG in combination with chronic ischemic heart disease) in the IIa and IIb stages. The control group included 32 practically healthy persons of the corresponding age. Along with standard diagnostic methods, the content of citrulline in serum was determined. Statistical analysis was performed using SPSS 10.0 for Windows. Results. There is a direct relationship between the increase in the content of citrulline and the severity of changes in the parameters of the functional state of the kidneys in patients with AG-II and CHF. At the same time, the fact that the content of citrulline in serum is much higher compared to the control values in patients with normal values of GFR, creatinine and microalbuminuria. As the increase in the content of citrulline directly correlates with the degree of deterioration of the functional state of the kidneys, and the kidneys are the only organ that regulates and controls the exchange of citrulline, the increase in its level in serum can be primarily associated with changes in kidney function in the examined patients. Conclusions. The content of citrulline in serum can be used as an additional marker for the presence of functional renal impairment in patients with cardiovascular and other diseases of the internal organs, especially in the early stages of development, as well as to assess the efficacy and safety of the use of drugs. This indicator needs further study involving more patients with different pathologies of the cardiovascular system and simultaneous monitoring of the functional status of the kidneys by standardized methods.
Published: 26 December 2018
Ukrainian Journal of Nephrology and Dialysis pp 48-61; doi:10.31450/ukrjnd.4(60).2018.07
Abstract:Chronic kidney disease (CKD) has become a global public health problem because of its high prevalence and the accompanying increase in the risk of end-stage renal disease, cardiovascular disease, and premature death. The role of uric acid (UA) in the pathogenesis and progression of CKD remains controversial. Although many evidence-based studies have suggested that UA itself may harm patients with CKD by increasing inflammation and CKD progression, the issue is still a matter of discussions. In this review we try to clarify what is hyperuricemia – cause of CKD, compensation, coincidence, consequence of CKD or it is only an epiphenomenon, and to evaluate current evidence of different types of targeted hypouricemic therapy effectiveness. So, to treat or not to treat?
Published: 26 December 2018
Ukrainian Journal of Nephrology and Dialysis pp 28-34; doi:10.31450/ukrjnd.4(60).2018.04
Abstract:The purpose of our work was to compare the effect of aceclofenac and meloxicam on the level of transforming growth factor-β1 (TGFβ1) and vascular endothelial growth factor in the blood and urine in chronic kidney disease (CKD) patients with rheumatoid arthritis (RA). Methods. RA patients were allocated into three groups: I group included the patients with RA without CKD presence (n = 47), group II – patients with RA with CKD stage 1 (n = 46), group III – patients suffered from RA with CKD stage 2 (n = 45). To form the group of comparison 20 healthy persons of appropriate age category were examined. Complex clinical-laboratory examination of all patients was performed during the period of extensive clinical manifestations (before nonsteroid anti-inflammatory drug (NAIP) administration), in a week and in 2 weeks during carrying out therapy with NAIP. Treatment was also carried out in accordance with the existing principles of therapy RA and of the revealed nephrologic diseases. In a complex of patients’ therapy aceclofenac was included. Influence of aceclofenac was compared with meloxicam. Concentrations of TGFβ1 and vascular endothelial growth factor (VEGF) in the blood and urine were studied using an immunofermental method. Results. In a week of anti-inflammatory therapy, a significantly decrease in the levels of the studied factors was found in all patients’ groups. The blood VEGF level was lower by 11.90% in the aceclofenac group compared to the meloxicam group. Urine VEGF and TGFβ1 levels were decreased by 5.53% and 39.40%, respectively, in patients with aceclofenac therapy compared with the meloxicam group. After two weeks of the aceclofenac therapy a significant decrease of TGFβ1 and VEGF in the blood (p
Published: 26 December 2018
Ukrainian Journal of Nephrology and Dialysis pp 3-10; doi:10.31450/ukrjnd.4(60).2018.01
Abstract:Hyperleptinemia is often observed in peritoneal dialysis (PD) patients. But, there are few studies on the relationship between blood leptin level and PD survival, and, some of them contradict each other. The present study aimed to investigate the impact of PD initiation on the serum leptin concentrations and its association with PD adequacy. Method. A total of 23 patients with end-stage renal disease (ESRD), who started the treatment with continuous ambulatory peritoneal dialysis (CAPD), were included in this prospective single-center observational longitudinal study. Among the patients, there were 15 men and 8 women; the average age of the patient population was 52.4 ± 12.3 years. The treatment with CAPD was performed using Dianeal PD 4 with glucose concentration of 1.36% and 2.27%. The patients were screened before PD initiation and after 3- and 12- month PD treatment. Leptin levels were determined in all patients using ELISA-method. Results. The median serum leptin concentration at study entry was 10.6 [5.6-21.9] ng/mL. Leptin level and its dynamics during the year after PD treatment initiation were dependent on body mass index (BMI). The overweight or obese patients had ever-increasing leptin levels after 3- and 12- month PD treatment. Whereas in the PD patients with normal weight, we observed a significant decrease of leptin levels after 12-month PD treatment. Serum leptin concentration in the women was significantly higher compared with the men (46.4 [1.1-95] vs 9.8 [3.2-14.5] ng/mL; p = 0.02). Blood cholesterol levels had a positive correlation with serum leptin concentrations after 3- and 12- month PD treatment: r = 0.53, p = 0.01 and r = 0.56, p = 0.008, respectively. However, we did not find a statistically significant association of leptin with PD adequacy parameters after 3- and 12- month PD treatment of the patients. In the Cox proportional hazard model adjusted for gender, serum leptin level demonstrated itself as the effective factor in PD adequacy survival: HR 5.3 (95% CI 1.7; 16.3). PD adequacy survival was better in the patients with leptin concentrations above the median (≥10.6 ng/mL) compared with the patients who had serum leptin levels below the median (log rank test, χ2 = 8.2; p = 0.0042). Conclusions. Our study have demonstrated markedly elevated serum leptin level in the overweight PD patients and its strong decrease during 12 months in the patients with normal weight. Low serum leptin level before PD initiation is associated with inadequate PD.
Published: 26 December 2018
Ukrainian Journal of Nephrology and Dialysis pp 40-47; doi:10.31450/ukrjnd.4(60).2018.06
Abstract:The purpose of this study was to define the frequency of renal dysfunction, including acute kidney injury (AKI), in cardiac surgery patients and its effect on outcome. Materials and methods. Patients 18 years old or older underwent cardiac surgery were included in the study. AKI and chronic kidney disease (CKD) was defined and staged according KDIGO 2012 guidelines. Glomerular filtration rate (GFR) was calculated with CKD-EPI formula. Clinical, laboratory and instrumental investigations were performed to all patients. As well, continuous hemodynamic monitoring was performed in postoperative period. Statistical analysis was conducted with SPSS for Windows v. 17.0.0. Results. 239 patients (170 (72,8 %) – male, 65 (27,2 %) – female) underwent cardiac surgery in M.M. Amosov National Institute of Cardio-Vascular Surgery between 29.06.16 and 30.10.16 were included in the study. 79 patients had a renal dysfunction before surgery: 19 (7.9%) – CKD and 60 (25.1%) – AKI. Renal replacement therapy (RRT) was used in 7 patients (4 — with CKD and 3 — with AKI). AKI was developed in 38 patients (15.9%) in postoperative period and RRT was started in one case. Statistically significant risk factors associated with AKI development in postoperative period were epinephrine usage (р
Published: 30 September 2018
Ukrainian Journal of Nephrology and Dialysis pp 10-17; doi:10.31450/ukrjnd.3(59).2018.02
Abstract:Мета роботи: визначити особливості HLA-фенотипів та показників цитокінової ланки імунітету з факторами ендотеліальної дисфункції у хворих на непроліферативні (НП) форми хронічного гломерулонефриту (ХГН) з нефротичним синдромом (НС). Матеріал та методи. Вивчали розподіл HLA-антигенів за допомогою мікролімфоцитотоксичного тесту Терасакі у 264 хворих на ХГН, НС (серед яких аналізували дані 96 з НП ГН) та 350 здорових донорів. Морфологічний діагноз був підтверджений методом тонкоігольної нефробіопсії. Для вивчення рівнів цитокінів та факторів ендотеліальної дисфункції в крові 110 пацієнтів використовували імуноферментний аналіз. Результати. Для ХГН, НС відносний ризик високий (RR> 2)за наявності HLA-А23, 24, 28, В8, 38, 41, 44 (у хворих на НП ГН +А30),причинна роль (σ> 0.1)показана для А24, 28, В8 (НП +A19+31+32); протекторами захворювання є В12 та В16 (НП +А9). Виявлені антигени-провокатори різних морфологічних форм ХГН. У пацієнтів з НП ГН виявлено в крові високі рівні як про- (трансформуючий фактор росту альфа (TNF-α), інтерлейкіну 17 (IL-17), моноцитарний хемоатрактантний протеїн 1 (МСР-1)), так і протизапальних (IL-4, трансформуючий фактор росту бета (TGF-β)) цитокінів, факторів ендотеліальної дисфункції (фактор росту ендотелію судин (VEGF), розчинна молекула адгезії судинних клітин (sVCAM-1)) та зниження Е-селектину. РівеньMCP-1 у хворих на проліферативні ГН був вищим, ніж у разі непроліферативних форм. Не виявлено достовірних змін цих показників імунітету в групі хворих на НП ГН після проведеного лікування, за винятком зниження TNF-α (р = 0,001), але позитивний ефект лікування асоціював з достовірним зниженням концентрацій МСР-1 (р = 0,005) і VEGF (р = 0,028). Висновки. Виявлені...
Published: 30 September 2018
Ukrainian Journal of Nephrology and Dialysis pp 3-9; doi:10.31450/ukrjnd.3(59).2018.01
Abstract:Проведення гемодіалізу / гемодіафільтрації вимагає наявності спеціально підготовленої води, яка є основним компонентом діалізуючого розчину. Джерелом води для діалізу є питна вода, що подається до каскаду очищення, та включає в себе, зокрема, процеси зворотного осмосу (ЗO). Належне очищення води є не лише запорукою безпечності процедури гемодіалізу, але й суттєво впливає на якість та тривалість життя пацієнтів. Контроль хімічної та мікробіологічної якість води, що використовується для діалізу дозволяє уникнути додаткового ризику для пацієнтів, які лікується гемодіалізом / гемодіафільтрацією
Published: 30 September 2018
Ukrainian Journal of Nephrology and Dialysis pp 31-37; doi:10.31450/ukrjnd.3(59).2018.05
Abstract:Гостре пошкодження нирок (ГПН) у дітей має поліетіологічну структуру, особливості перебігу залежні від віку захворювання і високий ризик розвитку хронічної хвороби нирок (ХХН) в катамнезі. Метою дослідження стало вивчення функціонального стану нирок у дітей, що перенесли ГПН, у віддалених термінах. Матеріали та методи. Було ретроспективно проаналізовано функціональний стан нирок (швидкість клубкової фільтрації (ШКФ)за Шварцом, рівень паратіреоідного гормону (ПТГ), альбумінурії (АУ), динамічної і статичної реносцинтиграфіі(РСГ)) за даними 60 історій хвороб дітей від 1 до 18 років, що перенесли ГПН протягом 2000-2016 р.р. Результати. Протягом першого року спостереження у 61,5% хворих зберігалась азотемія,, уповільнення ШКФ та високий рівень АУ. Подальше спостереження за цією групою хворих виявило тенденцію нормалізації рівнів креатиніну, сечовини, ШКФ, але зростання рівнів АУ. В динаміці спостереження від 5 до 15 років, визначено, що у 13,3% пацієнтів ШКФ становила від 90 до 85 мл/мін, а у 36,7% - від 85 до 30 мл/мін. У 46,7% дітей при не змінених показниках креатиніну і ШКФ, відмічено зростання рівню альбумінурії від 45 до 601 мг/добу. За період спостереження, від 15 років і більше, повністю одужало 53,3% дитини, у 31,6% хворих констатована хронічна ниркова недостатність (ХНН), а у 30,0% спостерігалось одужання з дефектом - стійке зниження функції з наявними маркерами пошкодження нирок. Висновки. Гостре пошкодження нирок частіше зустрічалось серед дітей перших 3 років життя, переважно у хлопчиків. Етіологічним чинником виникнення захворювання був гемолітико-уремічний синдром на фоні гострої кишкової інфекції. Повне одужання документоване у 20,0%...
Published: 30 September 2018
Ukrainian Journal of Nephrology and Dialysis pp 25-30; doi:10.31450/ukrjnd.2(59).2018.04
Abstract:It was shown previously on in vivo studies that proteinuria-induced effects play a crucial role in renal damage in chronic kidney disease (CKD). However, an initial mechanism of irreversible kidney damage in pediatric diseases characterized by chronic proteinuria, i.e. nephrotic syndrome, remains to be unclear. The aim of our work was to study the initial mechanism of kidney cells apoptosis development in nephrotic children. Methods.An examination of renal biopsies of 53 patients (aged 10 to 15 years) with nephrotic syndrome hospitalized in Pediatric Nephrology unit of the Children Clinical Hospital №7 (Kyiv, Ukraine) done. In vitro studies of albumin toxicity performed on rat proximal tubular cells in primary culture (RPTC). Results. Our study showed that albumin overload in nephrotic children leads to high levels of apoptosis. Its distribution and level varies regarding the level of focal segmental glomerulosclerosis (FSGS). The progression of sclerosis as a sign of irreversible kidney damage is accompanied by gradual increase in expression of proapoptotic factor Bax. In vitro studies on rat proximal tubular cells in primary culture (RPTC) showed that excessive albumin uptake into rat primary renal cells causes an almost immediate mitochondrial accumulation of the apoptotic factor Bax. We hypothesize that this might be initial pathway leading to kidney cells apoptosis in childhood nephrotic syndrome. Conclusions. We show thatoverexpression of apoptotic factor Bax has a place in children with nephrotic syndrome. Thus, chronic influence of albumin is a factor predisposing disturbances in system controlling apoptosis in this cohort of patients. Our data demonstrate that there is a dependence between the Bax overexpression level and the stage of CKD. We show the topologic difference between the Bax levels and FSGS degree. This is an indication thatdevelopment of glomerular and tubule-interstitial disorders under the influence of proteinuria occurs in specific range. In vitro data demonstrate that albumin overload causes mitochondrial Bax translocation that could be an initial factor in apoptotic pathway activation.
Published: 30 September 2018
Ukrainian Journal of Nephrology and Dialysis pp 50-60; doi:10.31450/ukrjnd.3(59).2018.08
Abstract:IgA nephropathy is the most common glomerulonephritis worldwide. This disease has a tremendous economic impact because renal replacement therapy is expensive and hard-to-reach. It also represents a social problem because children and young adults in their second and third decades of life are affected by the IgA nephropathy, and it is the most active period of human life with highest work productivity. Many retrospective studies have shown that 40% of biopsy-proven IgA nephropathy patients develop end-stage kidney disease in 20 years after their biopsy disease. The biomarker research in IgA nephropathy has experienced a major splash in recent years with great number of scientific reports. Individual biomarkers often lack sensitivity and specificity with impairment of disease specificity as a consequence. The review describes a novel approach based on a panel of biomarkers for pathogenic process of IgA nephropathy. Integration of genetic, clinical, and bioinformatics data sets could optimize the specific value of each biomarker in a multimarker panel. This is a inspirational and promising approach for precision medicine and personalized therapy in IgA nephropathy. Half a century into the original description of IgA nephropathy, there is still no specific therapy for this condition Although the scarcity in treatment advances could be related to the disease’s complex pathogenesis. The evolution of different therapeutic approaches is reviewed over time and resulted in the 2012 Kidney Disease: Improving Global Outcomes Clinical Practice Guideline for Glomerulonephritis that presently is being updated, and provide collation of recent data on various forms of immunosuppressive agents. Existing approaches to treatment of IgA nephropathy are described with focus primarily on innovative therapeutic strategies currently being evaluated in IgA nephropathy that were not discussed in the 2012 Kidney Disease Improving Global Outcomes Clinical Practice Guidelines.
Published: 30 September 2018
Ukrainian Journal of Nephrology and Dialysis pp 38-43; doi:10.31450/ukrjnd.3(59).2018.06
Abstract: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
Published: 30 September 2018
Ukrainian Journal of Nephrology and Dialysis pp 44-49; doi:10.31450/ukrjnd.3(59).2018.07
Abstract:Метою нашої роботи було порівняти показники оксидативного стресу дітей та дорослих хворих на пієлонефрит. Методи. Це дослідження зосереджено на вікових особливостях змін оксидантно-антиоксидантних параметрів та інтенсивності оксидативного стресу (ОС) у крові 252 дорослих та 123 дітей з пієлонефритом. Контрольну групу склали 68 здорових донорів одного віку та статі. Поряд із стандартними діагностичними методами визначали концентрації малонового діальдегіду у сироватці крові та еритроцитах, церулоплазміну, трансферину та SH-груп у сироватці крові, визначали активність глутатіонредуктази, глутатіонпероксидази та загальну активність пероксидази в еритроцитах, розраховували індекс ОС. Статистичний аналіз проводився за допомогою програм Statistica 10 для Windows та "MedCalc". Результати дослідження підтвердили підвищення концентрації малонового діальдегіду і карбонільних груп білків у крові та зниження антиоксидантних маркерів, а саме: концентрації трансферину, різних фракцій тіолових груп, загальної пероксидазної активності в еритроцитах, активності глутатіонредуктази і глутатіонпероксидази. Збільшення активності окислення ліпідів та білків на тлі зниження показників антиоксидантного захисту характерне для пацієнтів з хронічним пієлонефритом. Найбільша інтенсивність ОС та концентрація церулоплазміну в сироватці спостерігалася у дорослих пацієнтів з гострим пієлонефритом. Найвища активність перекисного окислення ліпідів та низький рівень антиоксидантного захисту крові характерні для педіатричних пацієнтів. Висновки. Таким чином, інтенсифікація ОС залежить від віку пацієнтів.
Published: 30 September 2018
Ukrainian Journal of Nephrology and Dialysis pp 18-24; doi:10.31450/ukrjnd.3(59).2018.03
Abstract:Наукові дані щодо дозозалежного впливу тривалого активатора рецепторів еритропоетину (ТАРЕ) на показники оксидативного стресу та перекисного окислення ліпідів мембран еритроцитів у хворих на хронічну хворобу нирок V, які лікуються гемодіалізом (ГД), є обмеженими. Метою нашої роботи було оцінити взаємозв’язок між застосованою дозою ТАРЕ та інтенсивністю оксидативних процесів у ГД пацієнтів. Матеріал та методи. 38 ГД пацієнтів були включені до одномоментного обсерваційного дослідження. Протокол дослідження був схвалений локальною етичною комісією ДУ «Інститут нефрології НАМН України». Усі пацієнти надали письму інформовану згоду на участь у досліджені. Пацієнти були стратифіковані за квартилями (≤ 25% та ≥ 75%) відповідно до середньої дози ТАРЕ і розподілені наступним чином: I групу склали хворі, які отримували ТАРЕ більше 6 місяців у дозі ≤ 50 мкг/міс (n = 20), до II групи увійшли хворі, у яких доза ТАРЕ склала ≥ 125 мкг/міс (n = 18). Поряд із стандартними діагностичними методами досліджували концентрацію малонового діальдегіду у сироватці (МДА) й еритроцитах (MДAe), вміст у крові церулоплазміну (ЦП) та трансферину (ТР). Крім того, визначали загальну пероксидазну активність (ЗПА) у еритроцитах, проникність еритроцитарних мембран (ПЕМ), підрахували відсоток гемолізу. Результати. У ГД пацієнтів, які лікувались ТАРЕ у дозі ≥ 125 мкг/міс визначено підвищення концентрації ЦР (р = 0,007) та ТР (р = 0,0003), тоді як ЗПА була статистично значуще зниженою порівняно з ІІ групою (р = 0,02). Крім того, У пацієнтів І групи встановлено вищий відсоток гемолізу (р = 0,03) та ПЕМ (р ˂ 0,0001). Використовуючи модель пробіт-регресії, ми визначили дозозалежний вплив...
Published: 17 June 2018
Ukrainian Journal of Nephrology and Dialysis pp 18-28; doi:10.31450/ukrjnd.2(58).2018.04
Abstract:The purpose of our work was to investigate the effect of immunomodulatory medicines on the intensity of oxidative stress (OS), the cytokines level and the activity of renospecific enzymes in patients with recurrent pyelonephritis (rPN). Methods. A prospective, randomized, open-label study involved of 100 women aged 33.4 ± 8.8 year old. According to the sensitivity of the detected pathogens all patients received antibacterial therapy for two weeks. Along with the main course of antibiotic therapy, 25 patients were assigned Sodium nucleinate at a dose of 0.25 g 4 times per day during 14 days, 18 patients were prescribed Galavit intramuscularly 2 ml per dayfor 10 days, and 27patients were prescribed Proteflazid according to the manufacturer’s instructions. The comparison group consisted of 30 women with rPN who received antibiotic therapy exclusively.Women were screened before and after the treatment. The content of malondialdehyde (MDA), ceruloplasmin (CP), transferrin (TF) and sulfhydryl groups (SH-groups) were determined in the blood by colorimetric method. Oxidative stress index (OSI) was calculated. The concentration of interleukins (IL) -1f, -4, -8, -10, -17, tumor necrosis factor a (TNF-a), transforming growth factor f (TGF-f), monocytic chemoactive protein-1 (MCP-1) and interferon y (IFN-y) were analyzed in the blood of the women using an ELISA. To evaluate the functional state of the renal parenchyma the activity of tubular lysosome enzymes a total f-N-acetylhexosaminidase and f-galactosidase were determined in urine. Results. The use of Sodium nucleinate decreased of the OS activity by reducing MDA level (p
Published: 11 June 2018
Ukrainian Journal of Nephrology and Dialysis pp 9-12; doi:10.31450/ukrjnd.2(58).2018.02
Abstract:The chorionic gonadotropin (CGT) test is used to diagnose and monitor the course ofpregnancy, including ectopic, to detect fetal abnormalities, trophoblastic diseases, preeclampsia, ovarian tumors, lungs, stomach, intestine, bladder, kidneys, prostate. The level of CGT is often elevated in postmenopausal women treated with hemodialysis (HD). Its significance is still not well understood, and therefore requires further study. The aim of our work was to investigate the level of CGT in postmenopausal women treated with HD. Methods. The determination of the level of CGT in 23 postmenopausal women treated with HD. The main inclusion criteria were as follows: oral informed consent of the patient to participate in the study, the presence of CKD stage VD and treatment of HD for at least 6 months. Exclusion criteria: severe functional disorders (liver, heart, respiratory failure), cancer processes, smoking, taking substitution hormonal therapy, lack of consent of the patient. The results were compared with the CGT levels in 20 healthy menopausal women (group II). Results. A statistically significant difference was found between the I group (postmenopausal women treated with HD) and II group (women without chronic kidney disease (CKD) (t = 3.62, p = 0.001). It was also found that CGT was increased in 9 (39%) of 23 women treated with HD. The norm of CGT in postmenopausal women is
Published: 5 June 2018
Ukrainian Journal of Nephrology and Dialysis pp 29-33; doi:10.31450/ukrjnd.2(58).2018.05
Abstract: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
Published: 4 June 2018
Ukrainian Journal of Nephrology and Dialysis pp 41-48; doi:10.31450/ukrjnd.2(58).2018.07
Abstract:The work is a literature review. Residual kidney function (RKF) is one of the crucial indicators of mortality and quality of life in patients with chronic kidney disease. Residual renal function provides better control of hydration, blood pressure, clearance of substances with low and middleweight, anemia, Ca/P metabolism, chronic inflammation. However, approaches to preservation of RKF in dialysis patients have been studied not enough, the importance of RKF preservation is underlined. The wide range of predictors of RKF loss are presented in the article, approaches to measurement of RKF, the relationship between level and presence of RKF with survival and mortality of patients with CKD 5D were analyzed. The possibility of RKF preservation and extension using different approaches by correction of dialysis prescription were estimated. There is no standardized method for applying incremental hemodialysis in practice. Onceto twice-weekly hemodialysis regimens are often used randomly, without knowing the benefit for current patient or how to escalate the dialysis dose if RKF declines over time. It is important to change the HD/HDF prescription according to the range of RRF using objective data.
Published: 29 May 2018
Ukrainian Journal of Nephrology and Dialysis pp 34-40; doi:10.31450/ukrjnd.2(58).2018.06
Abstract:Recent scientificstudies have demonstrated the effect of fibroblast growth factor 23 (FGF-23) on the volume and distribution of body fat. The aim of our study was to investigate of lipid metabolism in patients with chronic kidney disease (CKD) and its relationship with FGF-23. Methods. We conducted a single-center, cohort retrospective study involved 106 patients with CKD 1-5 stages. Among the patients were 47 women (44%) and 59 men (56%) aged (49.6±13.9) years. All patients were determined the blood lipid spectrum: total cholesterol level (LDL), high density lipoproteins (HDL) and triglycerides (TG). The lipid profile was examined using a biochemical analyzer Cobas Integra 400 Plus. The C-terminal FGF-23 fragment was determined using a set of reagents for the enzyme immunoassay “Biomedica” (Astria). The glomerular filtration rate (GFR) was calculated using the CKD EPI formula (KDIGO 2012). All the statistical analyses were performed using Statistica 10.0. Results. In patients with CKD, progressive decrease in the level of total cholesterol, LDL cholesterol, HDL cholesterol and the increase in TG concurrent with the fall in GFR was detected (p
Published: 29 May 2018
Ukrainian Journal of Nephrology and Dialysis pp 13-17; doi:10.31450/ukrjnd.2(58).2018.03
Abstract:The aim of our one-stage observational study was the detail analysis of structural, functional, endothelial peculiarities of diabetic nephropathy in patients with coexistent arterial hypertension. Methods. Our study involved 96people with arterial hypertension and type 2 diabetes mellitus (I group), 25 patients with arterial hypertension (II group), 15 practically healthy persons (III group) treated and obtained in Sumy City Clinical Hospital №1. Cardiovascular complications were determined in all patients from I and II groups. The average age of the patients was 62.31 ± 0.2 years. The level of glycosylated hemoglobin (HbAlc) was determined by the biochemical method, albuminuria by immunoassay. The level of endothelin-1 (ET-1) in serum was studied using ELISA. Results. It was found that the level of ET-1 was significantly higher in patients with diabetes compared with only hypertensive patients. In the patients with urine albumin excretion rate category A2 the level of endothelin-1 was significantly higher compared with the category A1 patients and less compared with category A3 patients (11.42 ± 49 vs 25 ± 0.57pg/ml, p = 0.0329 and 11.42 ± 0.49 vs 2.25 ± 1.04pg/ml, p
Published: 14 May 2018
Ukrainian Journal of Nephrology and Dialysis pp 3-8; doi:10.31450/ukrjnd.2(58).2018.01
Abstract:The aim of the work was to conduct a rating evaluation of nephrological services in the regions of Ukraine by using the method of complex statistical coefficients. Materials and methods. Evaluation of nephrological services in the regions of Ukraine was made by using indicators that characterize the structure, use of health care resources, quality and efficiency of its provision submitted to National Register of patients with chronic kidney disease and patients with acute kidney injury (2017). Results. The sum of integral indicators in different areas of our analytical research has identified Top-3 regions by number: nephrologists; hemodialysis (GD) machines, patients receiving GD; patients treated with peritoneal dialysis (PD); patients with functional transplanted kidney and in the prevalence of acute kidney damage (GFR) per million population. Summary. By using rating evaluation methodology, it was identified place of relevant region by each indicator of nephrological care in the region as a whole.
Published: 28 March 2018
Ukrainian Journal of Nephrology and Dialysis pp 49-61; doi:10.31450/ukrjnd.2(58).2018.08
Abstract:Пацієнтів з хворобою Фабрі (ХФ) відносять до групи високого ризику розвитку хронічної хвороби нирок та серцево-судинних захворювань. Застосування специфічної високовартісної терапії покращує перебіг цього рідкісного захворювання. Дана конференція KDIGOрозглянула суперечливі питання діагностики, скринінгу та менеджменту ХФ, включаючи ферментозамісну терапію та неспецифічну терапію супроводу для різних форм ХФ. Незважаючи на значні досягнення медичної допомоги та поліпшення наслідків захворювання, поглиблення знань щодо патогенезу цього глікосфінголіпідозу та визначення оптимального віку пацієнтів для початку лікування залишаються актуальними, а пошук більш ефективних специфічних методів лікування доцільним.
Published: 24 March 2018
Ukrainian Journal of Nephrology and Dialysis pp 32-37; doi:10.31450/ukrjnd.1(57).2018.02
Abstract:Purpose: to determine the frequency of diagnosis and predictors of renal disease in HIV-infected patients. Patients and methods. 292 HIV-infected patients, who were on an outpatient screening at the Chernivtsi Regional AIDS Center, were screened. Results CKD was diagnosed in 153 out of292 (52.4%) of the examined patients. among which 105 (36.0%) patients were diagnosed with isolated albuminuria/proteinuria, 48 (16.4%) patients had albuminuria /proteinuria, in combination with a decrease in glomerular filtration rate. It has been established that the presence of proteinuria in HIV infection is accompanied by a significantly higher level of HIV RNA compared to patients without this symptom (p < 0.01). At the same time, the average amount of CD4+-lymphocytes in blood serum in patients with proteinuria is significantly lower than in HIV-infected individuals who did not show kidney damage. The difference between the values of the ratios of CD4+/CD8+-lymphocytes in the analyzed groups (p < 0,05) is also significant. In most patients who were in the III-IV clinical stage of HIV infection, antiretroviral therapy (ART) was effective and reduced the viral load. Therefore, it is obvious that the amount of HIV-RNA in the blood of these individuals was significantly lower compared to patients who did not receive such treatment. At the same time, the burden of HIV, as well as the number of CD4+-lymphocytes in the representatives of the comparable groups did not differ (p > 0.05). Conclusion. The main predictors of kidney damage in HIV-infected are: high viral load, decrease in absolute numbers. CD4+-lymphocytes less than 200. Co-infection with hepatitis B and/ or C viruses does not affect the level of proteinuria and GFR in HIV-infected patients.
Published: 12 March 2018
Ukrainian Journal of Nephrology and Dialysis pp 38-43; doi:10.31450/ukrjnd.1(57).2018.03
Abstract:Girls performed the vast majority of patients with urinary system infections. The prevalence of acute disease and specific gravity of chronic kidney impartments have been increasing with the age and were often accompanied with concomitant urological, gynecological and sexual pathologies. The purpose of the work was to determine the etiological and clinical preconditions of relapse and chronic pyelonephritis in girls. Materials and methods. An analysis of the clinical course of187 cases ofpyelonephritis in girls of the age of1 - 18 years had been performing in period from 2008 to 2018 years. The 60 patients in observed group had acute process and 127 ones were with the chronic course of the disease. Rresults. E. coli was the main etiological factor of the inflammatory process in kidneys. Thus, cases of acute and chronic pyelonephritis composed 63,5% and 44,2% in observed group appropriately. Furthermore, the proportion of grampositive flora increased in the cases of chronic pyelonephritis. In addition, almost 56,7% ofall girls with pyelonephritis had sexually transmitted infections, more likely the patients with chronic forms of the disease (69,3% and 30,0%, respectively (p
Published: 9 March 2018
Ukrainian Journal of Nephrology and Dialysis pp 24-32; doi:10.31450/ukrjnd.1(57).2018.01
Abstract: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