Background. In patients after liver transplantation cardiovascular complications is the third main reason of death afer allograf failure and infections. The most important factors in the development of cardiovascular diseases are dyslipidemia and impaired renal function. The aim of the study was to investigate the lipid spectrum and renal function in liver recipients in real clinical practice and the correspondence of their correction to current clinical recommendations for the diagnosis and treatment of dyslipidemia and chronic kidney disease (CKD). Methods. A retrospective analysis of lipid spectrum and renal function in patients who underwent OLT in Research Institute – Regional Clinical Hospital №1, Krasnodar was performed. The level of creatinine, GFR and lipid spectrum was studied before and 36 months after liver transplantation. The GFR was calculated using the formula CKD‑EPI (Chronic Kidney Disease Epidemiology Collaboration). Statistical analysis of the study results was made using the program Statistica 10. Results. Liver recipients have a significantly higher total cholesterol by 31.0% (p<0.01) in comparison with the baseline before surgery. Total cholesterol was increased in 13.7% (p<0.01), triglycerides in 12.3% (p<0.01) before transplantation. Tree years after transplantation, the increasion in cholesterol was registered in 42.6% (p<0.01) and triglycerides in 37.9% (p <0.01), respectively. 3 years after transplantation reduction of GFR was observed in comparison with the baseline by 22.6% (p=0.00006). Verification of chronic kidney disease and statin administration in patients were carried out in some cases. The levels of total cholesterol and triglycerides had a reliable inverse correlation with GFR (r = ‑0.42; p<0.01 and r = ‑0.36; p<0.05). Conclusions. In the long‑term postoperative period there was an impaired lipid metabolism and decreased level of GFR. Dyslipidemia was closely related to the progression of renal dysfunction in liver recipients, an inverse correlation was established between the glomerular filtration rate and the increasion in cholesterol and triglyceride levels. It is necessary to increase the attention of physicians with regard to timely correction of lipid metabolism disorders and detection of initial manifestations of renal dysfunction.
The aim of the study– to evaluate the quality of life of patients after liver transplantation.Patients and methods. The quality of life of patients after liver transplantation was studied with the help of «SF-36 Health Status Survey» questionnaire and correlation analysis of all scales of the questionnaire with the MELD indices, Child-Pugh before transplantation, SCORE before and after transplantation, body mass index, immunosuppressants, presence of tumor, encephalopathy, hepatitis transplant was performed.The results. In the surveyed group, the average indicators on the scales «physical functioning» were reduced by 31.3%, «role functioning due to physical condition» - by 60.8%, «pain intensity» - by 13.2%, «general health condition» - by 33.4%, «Life activity» by 19.9%, «social functioning» by 19.8%, «emotional role functioning» by 52.9%, «mental health» by 11.7%, «physical component of health» by 24.5% and «psychological component of health» by 15.6%. Between hepatitis grafts and psychological health, as well as between the presence of tumors and pain intensity, the correlation coefficient is greater than 0.25, and the significance levels of both chi-square criteria are less than 0.05.Conclusions. Liver recipients have the lowest quality of life on the role-playing scale due to their physical condition compared to healthy liver recipients. A moderate statistically significant relationship between hepatitis grafts and psychological health, as well as the presence of tumors and pain intensity, has been revealed. There are no gender differences in all components of QL in the group of liver recipients.
The aim of the study is pharmacoepidemiologicalanalysis of the structureandreasonability of diuretic therapy in patients with hypertensive disease (HD)in ‘real-life’ clinical practicesettings.Materialandmethods:we underwentthe retrospectivepharmacoepidemiologicalcomparative analysisof the structureofdiuretic therapyreviewingoutpatient cardsfrom 2011 to 2014.We extracted data from outpatientcardsin outpatient department of Krasnodar Territoryusingcontinuous sampling method(421 patients)with the subsequent assessmentin accordance withmodern guidance materials. Results. In comparison with the regional study historic resultsthe administrationoftorsemidehad significantly increasedin patients withHD andnoncomplicatedchronic cardiac failure(12%).The priority drugs for the administrationamong diuretics werehydrochlorothiazide (24%)and indapamide (20%),spironolactone (20%).The ACE inhibitoror sartanusing in fixed combination with diuretic was recommended in 20% of out- patient cards.Structure ofdiuretic distribution in group of patients with HD, associated withCHF(II-IVfunctional class)had showedthe efficiencyof spironolactonein26%,of hydrochlorothiazide - 15%,torsemide - 13%,indapamide - 7%;the combination of spironolactoneandtorsemidewas receivedby 14% of patients,the combination of spironolactoneandhydrochlorothiazide - 6%,spironolactoneand furosemide - 1%,in 4% of outpatient cardswe noticed the triple combination of monocomponentdiuretic.Conclusion. We did not find unreasonable administration of diuretic therapy combination out ofindication and in the presence of contradictions.The prescription of modern long-termdiuretics associated with lower risk of side-effects developing will improve efficiencyand safetyof pharmacotherapy.It is very important to use fixed drugs combinationin case of administration the diuretic and agentsofrenin angiotensin system inhibitors.The volume and prescription reasonability analysis ofdiuretic therapy in patients withHDin ‘real-life’ clinical practicesettingshas shown compliance with modernnational guidance materials for the HD and CHF treatment.
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