Ukrainian Journal of Nephrology and Dialysis

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ISSN / EISSN : 23040238 / 26167352
Total articles ≅ 242
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Mykola Kolesnyk, L. Liksunova, T. Selezneva, T. Maistrenko
Ukrainian Journal of Nephrology and Dialysis pp 4-10; doi:10.31450/ukrjnd.4(64).2019.01

Abstract:Expenses for the treatment of end-stage renal disease (ESRD) patients with dialysis renal replacement therapy (DRRT) during the 2018 year constituted 2 billion 922 million 460 thousand UAH. Reimbursement from the state budget constituted 1 billion 44 million 800 thousand UAH. Expendable materials were the main component of DRRT. The share of the expendable materials price from total cost for hemodialysis and hemodiafiltration constituted 66%, for continuous ambulatory peritoneal dialysis and automatic peritoneal dialysis was 86.3% and 92.2%, respectively. The results of the investigation can be used for the development of a diversification model (state budget – local budgets – other sources) of financial expenses for the provision of dialysis treatment in ESRD patients as a part of the state program (strategy) health care finance and service delivery.
Lesya Korol, Natalia Stepanova, V. Vasylchenko
Ukrainian Journal of Nephrology and Dialysis pp 30-38; doi:10.31450/ukrjnd.4(64).2019.05

Abstract:This study aimed to investigate the arylesterase activity of paraoxonase 1 (PON-1) in patients with end-stage renal disease (ESRD) and its relationship with oxidative stress markers. Methods. We conducted a one-time prospective observational study involving 58 ESRD patients. Among them, there were 20 hemodialyses (HD) patients and 38 patients treated with peritoneal dialysis (PD). The activity of PON-1 in serum was determined spectrophotometrically by the number of phenolic complexes formed using phenylacetate. Besides, spectrophotometrically the concentrations of malondialdehyde, serum concentrations of ceruloplasmin, thiol groups and total peroxidase activity (TPA) of erythrocyte were determined. The reference group consisted of 30 conditionally healthy individuals. Results. The arylesterase activity of the PON-1 in reference group was 6.57 kU/L versus 2.25 kU/L in HD patients and 4.26 kU/L in PD patients (p ˂ 0.0001). A direct correlation was found between arylesterase activity of PON-1 and ceruloplasmin concentration (p = 0.004), and TPA (p = 0.02) in HD patients. The activity of PON-1 in the serum of PD patients was associated with high-density lipoproteins (p ˂ 0.0001). Conclusions. We observed a decrease in the arylesterase activity of PON-1 in ESRD patients compared to the control group. The lowest activity of PON-1 is determined in HD patients. Moreover, the association of the PON-1 activity with a decrease in antioxidant blood markers was found. The enzyme activity in PD patients correlated with increased blood HDL. Further studies involving a larger dialysis cohort of patients are needed to determine the pathogenetic role of PON-1 activity in the development of cardiovascular events in ESRD patients.
Iryna Dudar, I. Mykhaloiko
Ukrainian Journal of Nephrology and Dialysis pp 49-55; doi:10.31450/ukrjnd.4(64).2019.07

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. At present there is a number of experimental and clinical data that show that one of the important mechanisms of the pathogenesis of CKD is a violation of the blood coagulation system (hemostasis) both locally in the kidneys and with the capture of the microcirculatory channel of other organs, therefore an important task for specialists in the nephrology, as well as doctors of other specialties is understanding the functioning of the system of hemostasis in normal and in various kidney diseases and the correction of this pathology with drugs. There are several types of haemostasis disorders that may occur in CKD: disseminated intravascular coagulation syndrome (DIC), arterial and venous thrombosis and bleeding. In this review, we tried to determine the place of the DIC in the development and progress of the CKD and to assess the prospects for further research.
Ie. A. Burlaka, I.V. Bagdasarova
Ukrainian Journal of Nephrology and Dialysis pp 15-19; doi:10.31450/ukrjnd.4(64).2019.03

Abstract:Hypoxia-related disorders play an important role in irreversible kidney tissue damage via activation of certain secondary processes, i.e. apoptosis. This study aimed to investigate the levels of apoptosis controlling factors and nuclear transcriptional factor NF-κB in relation to the value of kidney function impairment; to evaluate possible protective effects of conventional therapy with the addition of an antioxidant agent tocopherol in pediatric patients with nephrotic syndrome. Methods. An examination of blood samples of 53 patients (aged 10 to 15 years) with nephrotic syndrome was performed. Conventional clinical investigations, immunoblotting were used in this study. Results. We demonstrate that nephrotic patients reveal a high level of pro-apoptotic marker Bax, low level of anti-apoptotic factor BcL-xL and anti-apoptotic unit of NF-κB (p65). Their dependence on level of kidney function impairment was detected. Applied treatment composes conventional scheme and tocopherol shows a restored balance of apoptosis controlling factor and NF-κB activity. Conclusion. Hypoxia-induces disorders in nephrotic children resulted in apoptosis controlling system disturbances can be attenuated by the antioxidants application.
Nihat M Hokenek, Mehmet O Erdogan, Davut Tekyol, Hakan Hançer, Ergul A Kozan, Ummahan Dalkilinc Hokenek
Ukrainian Journal of Nephrology and Dialysis pp 11-14; doi:10.31450/ukrjnd.4(64).2019.02

Abstract:Pericardial effusion secondary to contrast nephropathy is a very rare clinical condition. Patients have a volume load increase secondary to acute renal failure. In such a case, the progression of pericardial effusion with tamponade may follow a very rapid course contrary to what is believed. In this case, a 78-year-old male patient with diabetes mellitus and hypertension was admitted to the emergency department with complaints of decreased urine output, nausea, and vomiting. The patient was diagnosed with acute renal failure secondary to contrast nephropathy. Pericardial effusion amount was found to be 2 cm by thorax tomography. As the patient who had no urine output when his vital signs were stable became unstable during dialysis preparation and manifested clinical symptoms of cardiac tamponade, immediate pericardiocentesis was performed. Following that, he became stable and was transferred to the intensive care unit. In current guidelines regarding indications for pericardiocentesis, it is stated that drainage should be performed when the amount of effusion is more than 2 cm in the absence of tamponade, suspected bacterial infection or neoplastic etiology. However, in contrast to the standard approach to patients with acute renal failure, our suggestion is that the indications for pericardiocentesis may be broader in the presence of pericardial effusion.
O. B. Susla, Z. I. Litovkina, O. V. Bushtynska
Ukrainian Journal of Nephrology and Dialysis pp 39-48; doi:10.31450/ukrjnd.4(64).2019.06

Abstract:Systematic analysis of cardiac remodeling peculiarities in patients with V D stage of chronic kidney disease (CKD VD) caused by diabetes mellitus is important both in the stratification of cardiovascular risk and in the choice of adequate treatment strategies. The purpose of the study was to determine the character of structural and functional reconstruction of myocardium in patients with diabetic nephropathy (DN) on maintenance hemodialysis (HD) by identifying left ventricular hypertrophy (LVH), its geometric types, assessment of the severity of heart dysfunction, pulmonary hypertension (PH), as well as determination of frequency of cardiac valve calcification (CVC), development of defects of mitral (MV) and aortic (AV) valves. Materials and methods. The study included 136 patients on chronic HD (men, 78, age, (53,9±1,0) years, duration of HD, (47,6±4,2) months). Depending on the presence/absence of type 2 diabetes mellitus (DM) with kidney damage, they were divided into two groups: the first one – without DN (n=88); the second one – with DN (n=48). All patients were followed up by standard echocardiography (EchoCG) examination by standard procedure. Results. LVH was diagnosed in 84.6% of patients with CKD VD stage, significantly more often (93.8 vs. 78.4%, p=0.020) in patients with DN, with the incidence of eccentric LVH in the second group being higher (47.9 vs. 28.4%, p=0.023) than in the first one. Prevalence of pseudonormal and restrictive types of LV diastolic dysfunction (62.5 vs. 28.4%, p
M. Nisari, A. Yay, T. Ertekin, Ö. Al, D. Ceylan, G. Ö. Önder, M. Kavutcu
Ukrainian Journal of Nephrology and Dialysis pp 20-29; doi:10.31450/ukrjnd.4(64).2019.04

Abstract:The purpose of this research was to investigate the possible protective effect of melatonin, as a potent antioxidant on I/R-induced renal injury in rats. Methods. We used 28 female Wistar albino rats weight 200-250g. The rats were randomly divided into 4 groups. Control Group (C): They were fed with only standard rat diet and tap water without drug injections or ischemia-reperfusion. Melatonin Group (M): 25 mg/kg melatonin was administered i.p 30 min. Ischemia/Reperfusion Group (I/R): Rats were subjected to 45 min of renal pedicle occlusion followed by 24 hours reperfusion. Melatonin+ischemia/reperfusion Group (M+I/R): Melatonin (25 mg/kg) was administered 30 min prior to ischemia and immediately before the reperfusion period. Rats were subjected to 45 min of renal pedicle occlusion followed by 24 hours reperfusion. Results. While MDA levels increased in the I/R group, SOD and GST activities were seen to be significantly increased. Although the increase of the SOD activity was observed in the M+I/R group, no meaningful difference was found. MDA levels were significantly decreased in M+I/R group compared to the control group, CAT and GST activities were significantly increased. Conclusions. Our results show that the treatment with M may prevent kidney damage due to ischemia result in increasing oxidant stress peroxidation damages further. Melatonin or its metabolites are capable of neutralizing free radicals and non-radical oxygen-based reactants. This study suggests that melatonin may be an effective antioxidant agent.
N.G. Aleksieieva
Ukrainian Journal of Nephrology and Dialysis pp 56-61; doi:10.31450/ukrjnd.4(64).2019.08

Abstract:Chronic kidney disease leads to the accumulation of a wide range of uremic toxins. Negative effects of uremic toxins are most likely due to the combined effects of many uremic solutes, including small molecules, middle molecules, and soluble protein-linked substances. Large and medium-sized molecules are directly associated with chronic inflammation and adverse effects, including major cardiovascular risks and consequently poor prognosis. Recent advances in chemical composition and new production techniques led to improved biocompatibility and selective permeability of dialysis membranes. Specifically, the creation of a new class of membranes provided the possibility to improve the clearance of medium to high molecular weight (MW) solutes (i.e. uremic toxins in the range of 5–50 kDa). The new HDx therapy (expanded HD) is the next evolution in hemodialysis, as it effectively targets the removal of large middle molecules. The HDx therapy is enabled by the THERANOVA dialyzer featuring an innovative membrane that combines a higher permeability than regular high-flux dialyzers with effective selectivity for large proteins. Expanded hemodialysis is an advanced therapy targeting large and medium-sized molecules that are currently not possible to remove by modern dialysis methods including traditional hemodialysis (HD) and hemodiafiltration (HDF). HDx became possible due to THERANOVA, a new dialyzer with an innovative membrane. The THERANOVA-based HDx provides a great new opportunity for dialysis patients, providing unique high-efficiency hemodialysis with the usage of already available infrastructure and standard HD workflows.
F. O. Prusskiy
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.
L. Lebid, L. Snisar, L. Liksunova
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.