Chronic Kidney Disease: Current State of the Problem

Chronic kidney disease (CKD) is characterized by increasing prevalence, catalyzing properties in relation to cardiovascular and general mortality, and, in most cases, is asymptomatic, which means late diagnostic verifiability. The global average prevalence of CKD is 13.4%, and CKD C3-5 is 10.6%. The main causes of CKD C5 are diabetes mellitus (DM, 46.9%), hypertension (28.8%) and to a lesser extent, glomerulonephritis (7.1%) and polycystic diseases (2.8%), while other causes account for a total of 14.4%. Despite the simple diagnosis of CKD, one of the key problems of modern therapeutic and pediatric clinics is its low detection rate at the early stages, which, according to some data, reaches 96.6%. This review provides data on the criteria for the diagnosis of CKD, as well as more detailed consideration of the course of CKD in patients with DM, hypertension, and heart failure. Attention is paid to the medicinal origin of CKD, as well as to the development of anxiety and depressive disorders in CKD. General issues of treatment of patients with CKD are considered in detail. Lifestyle changes are an important part of the fight against the development and progression of CKD. Currently, Smoking, alcohol, and physical inactivity have been shown to have a harmful effect on the risk of developing and progressing CKD. Diet plays a certain preventive role. The main drugs with nephroprotective properties are angiotensin-converting enzyme inhibitors and angiotensin II receptor antagonists. Both classes of drugs are effective in proteinuric forms of nephropathies and in combination/association of CKD with diabetes or hypertension. The review also provides data on the nephroprotective properties of mineralocorticoid receptor antagonists, endothelin receptor antagonists, and sodium-glucose co-transporter-2 inhibitors. Given the high importance of identifying and effectively treating patients with CKD, it is necessary to focus on early detection of CKD, especially in high-risk groups. It is necessary to raise public awareness by creating and implementing programs for primary prevention of CKD, as well as awareness of patients, motivating them to follow the doctor's recommendations for a long time, including as part of the implementation of a non-drug strategy to combat CKD. It is important to use the full range of methods of drug therapy for CKD, including measures of universal nephroprotection. It should be remembered that the cost of late diagnosis of CKD is a reduction in life expectancy, primarily due to high rates of cardiovascular mortality, disability, and high-cost medication and kidney replacement therapy.

Mitochondria as a Signaling Hub and Target for Phenoptosis Shutdown

Mitochondria have long been studied as the main energy source and one of the most important generators of reactive oxygen species in the eukaryotic cell. Yet, new data suggest mitochondria serve as a powerful cellular regulator, pathway trigger, and signal hub. Some of these crucial mitochondrial functions appear to be associated with RNP-granules. Deep and versatile involvement of mitochondria in general cellular regulation may be the legacy of parasitic behavior of the ancestors of mitochondria in the host cells. In this regard, we also discuss here the perspectives of using mitochondria-targeted compounds for systemic correction of phenoptotic shifts.

[The agreed experts' position of the Eurasian Association of Therapists on tactics of management of patients with comorbid pathology infected with SARS-Cov-2]

The agreement of experts of the Eurasian Association of Therapists (EAT) discusses pathogenesis and treatment of COVID-19. Modern data on the characteristics of cardiovascular, kidney, respiratory damage in SARS-infected CoV-2 are presented. The tactics of managing patients initially having cardiovascular diseases, diabetes mellitus, chronic obstructive pulmonary disease, bronchial asthma, chronic kidney disease are discussed in detail. The article presents data on drug interaction of drugs.

[Estimated methods of predicting risk of analgetic interstitial renal disease]

AIM

Screening of renal pathology and investigation of its dependence on intake of metamisol, the risk of nephritis associated with metamisol.

MATERIAL AND METHODS

The study included 1446 inpatients (mean age 49.63 +/- 0.43 years, 690 males--48%, 756 females--52%). Analysis of the urine, tests for urea, blood creatinine, estimation of glomerular filtration rate were made. Metamisol doses and duration of analgetic treatment were controlled in 658 patients. Statistical processing was made with Statistica 6.0 soft.

RESULTS

Of 1446 examinees, 346 (23.9%) patients took analgetics. Out of 98 patients treated with metamisol, 34 (34.7%) had pathology of urinary sediment, 18 (18.4%) had suppression of renal function (RF) while in patients untreated with analgetics this percentage was 7.4 and 16.1%, respectively, p < 0.05. In intake of metamisol from 0.5 to 5.0 kg and more changes in urine analysis parameters and regress of RF were more prominent than in intake up to 0.5 kg (p < 0.05). Application of nonlinear logistic regression analysis provided equations of logistic regression making it possible to assess probability of changes in urine analysis and renal function decline depending on the drug dose and duration of its intake.

CONCLUSION

Inpatients often take analgetic drugs, especially metamisol. Its high doses are associated with risk of renal function decline and pathology of urinary sediment. Equations of calculation of renal affection risk in administration of metamisol are presented.

[Renal dysfunction in patients with ischemic heart disease]

We studied effects of various forms of coronary heart disease on the progression of renal dysfunction. Three groups of patients were examined: 1--patients with exertional angina (n = 29), 2--patients with old myocardial infarction (postinfarction cardiosclerosis) and exertional angina (n = 22), 3--patients with atrial fibrillation and exertional angina (n = 21). Most pronounced anatomic and functional abnormalities of cardiac action and respective statistically more significant renal dysfunction were revealed in group 3.

[Cardiovascular effects of omega-3 polyunsaturated fatty acids: position of omega-3 polyunsaturated fatty acids in Russian and international guidelines. Council of Experts]

This Expert Council focuses on the meta-analysis of studies on the risk of atrial fibrillation (AF) in patients taking omega-3 polyunsaturated fatty acids (PUFA) and of data on the omega-3 PUFA treatment in patients with cardiovascular and kidney diseases.The major statements of the Expert Council: the meta-analysis of AF risk in patients taking omega-3 PUFA showed an increased risk of this arrhythmia. However, it should be taken into account that the risk of complications was low, and there was no significant increase in the risk of AF when omega-3 PUFA was used at a dose of ≤1 g and a standard dose of the only omega-3 PUFA drug registered in the Russian Federation, considering all AF episodes in the ASCEND study.At the present time, according to Russian and international clinical guidelines, the use of omega-3 PUFA can be considered in the following cases: • for patients with chronic heart failure (CHF) with reduced left ventricular ejection fraction as a supplement to the basic therapy (2B class of recommendations according to the 2020 Russian Society of Cardiology guidelines (RSC) and the 2022 AHA / ACC / HFSA guidelines); • for patients with hypertriglyceridemia (&gt;1.5 mmol/l) as a part of combination therapy (IIb class of recommendations and B level of evidence according to the 2021 European guidelines on cardiovascular disease prevention, etc.); • for adult patients with stage 3-4 chronic kidney disease (CKD), long-chain omega-3 PUFA 2 g/day is recommended for reducing the level of triglycerides (2C class of recommendations). Data on the use of omega-3 PUFA for other indications are heterogenous, which can be partially explained by using different form and doses of the drugs.

CLINICAL FEATURES OF THERAPY OF ANEMIA AND THE SIGNIFICANCE OF ITS FLUCTUATION IN THE DEVELOPMENT OF ANEMIA IN DIALYSIS PATIENTS

The aim of our study was to examine the features of therapy of anemia, and the influence of fluctuation in dose of antianemic drugs on hemoglobin levels in dialysis patients. The study included 100 patients with chronic kidney disease stage 5D receiving hemodialysis, mean age was 53,4±15,8 years. The clinical and anamnestic data were studied and laboratory tests were performed in all patients. The correlation between hemoglobin level and fluctuations in dose of antianemic drugs for 12 months: erythropoietin (R= -0,51, p=0,004) and iron (R= -0,46, p=0,01) was determined. The higher doses of erythropoietin and their fluctuation and the fluctuation in dose of iron drugs were observed in the group of patients with middle degree anemia. The least fluctuation of erythropoietin and iron drugs was detected among patients with normal hemoglobin level. There were the correlation between the dose of erythropoietin used in the last month with transferrin (R=-0,25, p=0.011) and ferritin (R=0,22, p=0.028)and the relationship of fluctuations in dose of antianemic drugs and parameters of ferrokinetic, in particular, between the fluctuation in dose of iron drugs for 6 months and ferritin index (R=0,38, p=0.008), and soluble transferrin receptors (R=-0,37, p=0.01). Thus, high variability of doses of antianemic drugs determines less successful erythron's response to the treatment in dialysis patients, which indicates the need of monitoring the fluctuation of drug's doses.

[Medico-genetic prediction of cerebral stroke risk]

A population family study including 1410 residents of Rostov region (280 families) was conducted. The study included questioning and analysis of medical records for the presence or absence of chronic diseases, including cardiovascular pathology, arterial hypertension, coronary heart disease, diabetes mellitus, and their complications, cerebral stroke (CS) and myocardial infarction, as well as the time of their occurrence. Statistic analysis included conventional descriptive statistics and regressive analysis, as well as a special part, population genetic analysis. The results showed that MI mortality was 21.4 times higher in the group of a high genotypic risk vs. the low risk group, 8.1 and 0.38%, respectively. The authors developed tools of MI risk prediction depending on hereditary burden, the use of which present a significant addition to the conventional system of phenotypic risk assessment. In order to adapt calculations to practical healthcare, the authors developed risk charts which allow MI risk assessment according to the magnitude of risk factors.

[The Nephrological Aspects of the Use of Rivaroxaban and Other Direct Peroral Anticoagulants in Non-Valvular Atrial Fibrillation]

Chronic kidney disease (CKD) is a powerful cardiovascular risk factor, its presence is accompanied by an increased risk of hospitalization for exacerbation of chronic heart failure (CHF), adverse outcomes in myocardial infarction, and cardiovascular mortality. Among the adverse events, an increased risk of atrial fibrillation (AF) should be noted. This article contains discussion of current approaches to the treatment of AF in patients with different stages of CKD, data on benefits of certain direct oral anticoagulants, as well as comparative characteristics of therapy with direct oral anticoagulants and warfarin. Pharmacokinetics and pharmacodynamics of direct oral anticoagulants, which determine the features of therapy in CKD, are also considered.