* Роботу виконано в межах планової наукової тематики ДУ «Інститут нефрології НАМН України» «Вивчити патогенетичні механізми формування коморбідності у хворих на хронічну хворобу нирок VД стадії» (державний реєстраційний № 0119U000001). Установою, що фінансує дослідження, є НАМН України. Автор гарантує повну відповідальність за все, що опубліковано в статті. Автор гарантує відсутність конфлікту інтересів і власної фінансової зацікавленості при виконанні роботи та написанні статті. Рукопис надійшов до редакції 18.02.2020.
Abstract. The aim of the study was to analyze the characteristics of serum concentrations of oxidative stress (OS) markers depending on the quantitative assessment of comorbidity and taking into account the most informative indicators of OS, to prospectively assess changes in comorbid status, death rates and individual comorbid conditions in patients with end-stage renal disease (ESRD) treated with hemodialysis (HD). Methods. The cohort prospective open-label study included 156 patients with ESRD, treated with HD. The study was conducted in two stages. In the first – the structure and quantitative assessment of comorbid diseases, determination of serum concentrations of oxidative stress (OS) markers and their analysis depending on the comorbid status were studied. On the second – taking into account the defined threshold values (Cut-off) of the most informative markers of the OS, an assessment of changes in comorbid status, frequency of comorbid conditions and fatal events done. A modified polymorbidity index (MPI) was calculated to assess comorbid status. The concentration of OS serum markers was determined by spectrophotometric method. Statistical analysis was performed by using "MedCalc", version 19.3 (Ostend, Belgium). Results. Serum concentrations of all prooxidant markers were significantly higher and antioxidant markers were significantly lower in the HD patients with high comorbid status compared to those of patients with low comorbidity (p<0.0001). Correlation analysis between MIP and the studied OS markers showed that the largest correlation (rho=0.874) was established with the serum concentration of malondialdehyde (MDAs). During the observation period in the group of patients with a concentration of MDAs > 668.72 μmol/ml found a significant, compared with the group with a biomarker content ≤ 668.72 μmol/ml, an increase in the proportion of patients with chronic obstructive pulmonary disease (COPD) (by 81.84 % vs 28.48 %; p<0.0001), cardiovascular diseases (CVD) (by 56.0 % vs 36.4 %; p=0.019) and cerebrovascular (CEVD) diseases (by 73.33 % vs 30.42 %; p<0.0001). The proportion of patients with fractures in the group of patients with MDAs > 668.72 μmol/l increased fourfold (p=0.0140). The increase in MIP is 34.11 % vs 17.1 % (p<0.0001), five-year cumulative survival – 45.3 % vs 63.3 % (p=0.0312; HR – 2,1527, 95% CI: 1,2458 –3,7199), five-year CV survival – 61,6 % vs 80.8 % (p=0.0094; HR – 2.7955, 95% CI: 1.3664 – 5.7191) in groups with MDAs > 668.72 and ≤ 668.72 μmol/ml, respectively. Conclusions. In patients with ESRD, treated with HD, serum concentrations of MDAs > 668.72 μmol/l is a biochemical determinant of a significant increase, in the medium term, the number of comorbid conditions, deaths, fatal CV and CEVD events, the proportion of patients with COPD, fractures, CVD and CEVD, reduction of cumulative and CV survival.
Annual expansion of dialysis population, high mortality, considerable expenses on specialized medical care are evoked the medical community to research comorbidities, that undoubtedly has an influence on course of chronic kidney disease VD stage (CKD VD st.) and prognosis. Aim. The aim of this study was to investigate the prevalence and structure of comorbid conditions in patients with CKDVD stage, and determinate the relation between comorbidities and survival rate in dialysis population. Materials and methods. It was studied the prevalence and structure of comorbidities among 204 patients with CKD VD st. (125 on hemodialysis [HD], 51 on peritoneal dialysis [PD], and 28 on hemodiafiltration [HDF]). All recorded concomitant diseases with its incidence data and coand polymorbidity indices were analyzed in consideration of renal replacement therapy (RRT). The survival rates were assessed in according with indices of comorbidity by Kaplan - Mayer methodology. Results. The performed analysis was demonstrated that in almost single patient had no mononosologicalpathology. The numbers of concomitant diseases were 3,55, 3,3 и 3,4 3,3per patient on HD, HDF and PD, respectively, without significant relation with RRT modality. In according with the study results the most common comorbid conditions, irrespective from RRT modality, were anaemia (88%), arterial hypertension (86%), and secondary hyperparathyroidism (40%). The proposed modified index of polymorbidities was revealed as the universal marker of survival rate in patients with CKD VD st. Conclusion. Thus the considerable prevalence of comorbid conditions in population ofpatients with CKD VD st. irrespective of RRT modality has significant negative effect on prognosis.
Despite of significant development of dialysis technology, mortality rates of CKD V D stage patients remain unsatisfactorily high. Next to cardiovascular diseases, infections are seems to be as a major causes of morbidity, hospitalization and mortality in this population. Staphylococcus aureus, especially MRSA, infections are a major cause of morbidity and hospitalization in CKD V D stage patients. Preceding MRSA colonization views as a risk factor for subsequent MRSA infections in future. Aim. The aim of this study was to explore the effects of opportunistic pathogens colonization on survival in patients with CKD VD stage. Materials and methods. This prospective cohort, open-label study included 255patients with CKD V D st. (198 HD and 57 PD patients). Patients were randomized into two groups, depending on the MRSA colonization history: first group (n=66) included patients with identified MRSA colonization and the second group (n=189) included patients with colonization of other opportunistic pathogens. The groups were representative according to gender, age, type of kidney affections and renal replacement therapy (RRT) modality. The endpoint was the total number of deaths. All cases, which took place from 01.08.2011 to 01.08.2016 year, were analyzed. The Kaplan-Meier method was perfomed for evaluation of survival. Results. The analysis allowed to state that during analyzed period in total were 75 deaths: in the first group ofpatients - 32 (48.5%), and in the second - 43 (22.8%) cases; %2= 14,38, p = 0,000078; RR – 2,131, 95% ffl: 1,484-3,060. The survival rate of patients was significantly lower in the first group, irrespective of RRT modality. The 3-years cumulative proportion surviving was 53% and 79% in the first (MRSApositive) and second groups, respectively; p< 0,001. Conclusion. This study demonstrated that MRSA asymptomatic colonization has a significant negative effect on survival in the patient population with CKD VD stage
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