BACKGROUND. Chronic kidney disease (CKD) is a common pathology influencing mortality risk in the world population. Calcification of aorta and heart structures (valves, coronary arteries) is a risk factor for cardiovascular complications. The influence of cytokines, integrin proinflammatory indices, acute phase proteins and other inflammatory factors on the risk of extravasal calcification is promising. THE AIM: to study the effect of cytokines, integrative proinflammatory indices, acute phase proteins and other inflammatory factors on the risk of extra-osseous calcification. PATIENTS AND METHODS. A one-stage, cohort study of 85 patients with CKD 5D treated with programmed hemodialysis was conducted. General clinical examination was carried out according to the protocol. Blood levels of C-reactive protein (CRP) were determined by immunoturbodimetry. A Glasgow Prognostic Score (GPS) risk index for systemic inflammation was calculated using CRP and plasma albumin concentrations. Interleukin-6 (IL-6), interleukin-3 (IL-3) were assessed by enzyme immunoassay. Blood leukocyte shift index (BLI) was calculated. Echocardioscopy was performed using Doppler mode. The presence of cardiac valve calcification (CAC) was registered, its severity was assessed. To estimate the abdominal aortic calcification, the abdominal radiography was carried out in the left lateral projection. The severity of manifestations of aortic calcification was assessed using the L.I. Kauppilla Calcification Scale. Statistical analysis was performed using STATISTICA 12.6. toolkit (StatSoft, USA). RESULTS. Systemic inflammatory factors negatively affected the severity of cardiovascular calcification. An increased GPS value was found to correlate with the severity of CAC and CSA. In the case of calcification severity analysis considering IL-3 and IL-6 values, it was also shown that high levels of these pro-inflammatory cytokines are associated with severe manifestations of anterior aortic wall calcification and aortic calcification at the L3 level. Inclusion of ISLC in the analysis had no effect on the severity of calcification of the aortic wall and no effect on the intensity of cardiac valve calcification in general, the aortic valve and the mitral valve in particular.
BACKGROUND. The role of inflammation and uremic intoxication in the development and progression of bone mineral disorders, including cardiovascular calcification, has been actively studied over the past decades. PATIENTS AND METHODS. A single-stage, cohort study of 85 patients with stage 5D CKD treated with programmatic hemodialysis was conducted. The blood concentrations of interleukin-3 (IL-3) and interleukin-6 (IL-6) were determined using the enzyme immunoassay, the level of fibrinogen - using the Rutberg method, and the level of p2-microglobulins - using the nephelometric method. The blood leukocyte shift index (ISLC) and the Glasgow Prognostic Score (GPS) risk index for systemic inflammation were also calculated, taking into account the level of C-reactive protein (CRP) and blood albumin. The presence of valvular calcification, its severity, and calcification of the abdominal aortic wall was recorded. Statistical analysis was performed using the program STATISTICA 12.6 ("StatSoft", USA). THE AIM: to evaluate the relationship between factors of systemic inflammation and cardiovascular calcification in patients with stage 5D chronic kidney disease. RESULTS. The risk of detecting calcification of the aorta and heart valves was influenced by the pro-inflammatory cytokines IL-3 and IL-6, as well as ISLK and GPS. However, inflammatory factors such as fibrinogen, p2-microglobulin, and CRP levels in the blood did not show a statistically significant effect. In the case when the predicted parameter was chosen not friendly calcification, but the presence of any of its components, the predictive significance of IL-3 decreased, but IL-6 remained. The 20% risk threshold was exceeded at IL-6 values of more than 33 pg/ml. The effect of ISLC on the probability of detection of calcification was shown both about friendly calcification and concerning isolated calcification of the aorta or valves. CONCLUSION. It was found that among the studied factors of inflammation, IL-6, ILK, and IL-3 demonstrate a relationship with the processes of cardiovascular calcification, GPS-only in relation to friendly calcification. Nomograms have been developed that allow predicting the detection of cardiovascular calcification in dialysis patients, depending on the state of the inflammatory circuit.
The imperfection of the normative legal acts regulating legal relations between participants and subjects of obligatory medical insurance (OMI) inevitably leads to the impossibility or difficulties for the parties to fulfill their obligations in provision of medical care to insured persons within the framework of OMI programs. Medical organizations included in the unified register of medical organizations operating in the field of OMI are limited in providing medical care to citizens under the state guarantees program in the case of excess of the volume of medical services provided from the planned services provided for by the OMI agreement. The “forced” provision of “supervolume” medical care is primarily aimed at meeting the actual need of patients for this service. This fact neglect by medical organizations is unacceptable and contradicts the basic principles of protecting the health of citizens, namely, the priority of its provision in the field of health protection, since malignant neoplasms are classified as socially significant. The inadmissibility of refusal to provide medical care and the revision of legal instruments for its provision in order to avoid a negative impact on patients suffering from oncopathology and on the performer represented by a medical organization is the topic of this discussion. Contractor’s submission of payment for medical care in excess of the distributed volume and (or) financial security established by the medical organization in accordance with the legislation on obligatory medical insurance should not be a reason for refusing to provide medical services at the time of the consumer's request and in the future. At the same time, acts of medical and economic control were drawn up based on the results of examinations conducted by insurance medical organizations for monitoring the volume of medical care for identified cases of medical care in excess of the distributed volume established by the decision of the commission for the development of the territorial program. Non-payment by insurance medical organizations of bills for the rendered medical services, motivated by the excess of volumes and financial support established by the territorial OMI program, serves as the basis for the medical organization to file a lawsuit.
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