In January 2021, there were 9,648 patients in Ukraine on kidney replacement therapy, including 8,717 on extracorporeal therapies and 931 on peritoneal dialysis. On 24 February 2022, foreign troops entered the territory of Ukraine. Before the war, the Fresenius Medical Care dialysis network in Ukraine operated three medical centres. These medical centres provided haemodialysis therapy to 349 end stage kidney disease patients. In addition, Fresenius Medical Care Ukraine delivered medical supplies to almost all regions of Ukraine. Even though Fresenius Medical Care's share of end stage kidney disease patients on dialysis is small, a brief narrative account of the managerial challenges that Fresenius Medical Care Ukraine and the clinical directors of the Fresenius Medical Care centres had to face, as well as the suffering of the dialysis population, is a useful testimony of the burden imposed by war on these frail, high-risk patients dependent on a complex technology such as dialysis. The war in Ukraine is causing immense suffering for the dialysis population of this country and has called for heroic efforts from the dialysis personnel. The experience of a small dialysis network treating a minority of dialysis patients in Ukraine is described. Guaranteeing dialysis treatment has been and remains an enormous challenge in Ukraine and we are confident that the generosity and the courage of Ukrainian dialysis staff and international aid will help to mitigate this tragic suffering.
The object was to study the effect of oxidative factors and methods of renal replacement therapy (RRT) on indices of oxidative stress (OS) and resistance cells in blood in patients with chronic kidney disease stage V(CKD VD) and anemic syndrome. Material and methods. The study involved 47 patients with CKD VD: 14patients were treated by hemodiafiltration (HDF), 14 patients by hemodialysis (HD) and 19 patients by peritoneal dialysis (PD). The severity ofanemia was assessed according to the KDIGO (2012) criteria. The control group consisted of30 healthy people of the same age and sex. Along with the standard diagnostic methods, we defined the content of malonic dialdehyde in serum (MDAs) and in erythrocytes (MDAe), the content of ceruloplasmin (CPs), transferrin (TRs) and SH - groups in the blood serum, the index of the OS (IOS), catalase activity in serum (CTs), glucose - 6 - phosphate dehydrogenase (G - 6 - PDHe) and total peroxidase activity (TPA) in erythrocyte, osmotic (OR) and peroxide resistance (PR) of red blood cells and erythrocyte membrane permeability (EMP). Statistical analysis was performed using the programs Microsoft Excel 5,0 and MedStat. Results. It has been stated that in the CKD VD patients agains the rates in control group the MDAs content increased by 3.3 times and MDAe - 1.2 times, TRs content reduced by 34%, SH - groups - by 31%, TPAe - by 41% and G - 6 - FDGe - by 58%, marcers of OR by 30%, PR - by 60%; 4.6 times increased CTs activity and OSI; 2 times grew peroxide hemolysis (PH) and 1.3 times - EMP. The analysis (depending on the RRT modality) showed that the patients treated by HDF had typical MDAs increase by 3.9 times on a background of CPs by 24%o, TRs - 33%, SH - groups - 25%, TPAe - 51%, G6 - PDHe - 42%; the increase in serum OSI - 5.4 times and 2.6 times in erythrocytes, PR - by 3.6 times and CTs activity by 3,5 times; HD group were characterized by the highest value of MDAe, OSI, PH and CTs, along with more expressed decrease of indices TRs, SH - groups, TPA and G - 6 - FDHe activity compared with rates in patients with HDF. The patients treated with PD had the lowest content of MDAs and the highest values on the background ofTPAe, the significant increase of CPs by 1.7 times and lowest TRs and G - 6 - PDHe. The patients with PD showed twice lower OS activity by OSI. Conclusion.Thus, in patients with CKD VD, who had HD, HDF or PD an anemic syndrome was associated with high OS activity and the increased degree of hemolysis. These changes are stipulated by RRT methods: for patients receiving HDF were typical the lowest rates of hemolysis and the highest degree of protection for erythrocytes, and for patients treated with HD - the highest OS.
Abstract. The occurrence of an emergency situation (ES) forced international (ISN, EDTA/ERA) and national (Turkey) nephrological associations to establish the Renal Disaster Relief Task Force, which is primarily concerned with the treatment of patients with acute kidney injury and end-stage renal disease requiring dialysis. The war started by the RF is putting the Ukrainian state, Ukrainian society, and the healthcare system in the catastrophic ES. Under these circumstances, all nephrological patients became one of the most vulnerable categories of patients. To provide immediate support in solving problems within the Ukrainian Association of Nephrologists and Kidney Transplant Specialists (UAN&KTS), the Ukrainian Renal Disaster Relief Committee (URDRC) has been established. One of the most important tasks was to form a group of experts to develop recommendations for specialized medical care for kidney patients in wartime. According to the experts, the key person for this type of medical care is the leading nephrologist in the region or city. He/she establishes a local Renal Disaster Relief Committee (LRDRC) and decides through horizontal (with other LRDRC) or vertical (with UAN &KTS) collaboration, using available communication tools, on the problems that arise; the most appropriate tool is the Viber platform "Nephrology. Dialysis. Transplantation". In this way, a network without administrative subordination and a non-hierarchical functional system was created, which, on the one hand, functions according to similar working principles, but, on the other hand, may differ in terms of LRDRC composition, communication methods, and more. The LRDRC divides all patients into three groups and provides work preparation measures before, during and after the cancellation of ES.
the article describes approaches to cost optimization of anemia treatment in CKD–VDst. patients by comparison of costs in phase correction and support treatment with long action ESA in patients on HD and HDF. Aims. To reveal the influence of HD and HDF to summary dozes of ESA in anemia treatment, to reveal the influence of different long action ESA to hemoglobin variability and find connection between HD, HDF and ESA type to cost of ESA using. Materials and methods. There were 14 patients on HD and 14 on HDF. All patients were treated with dialysis 3 time per week, session duration was 4,5–5 hours. eKt/У were 1,39±0,06 in HDF group and 1,29±0,07 in HD group. Mean hemoglobin was 98,3±2,46 g/l in HDF group and 92,76±2,46 g/l in HD group. In correction phase we used pegylated erythropoietin–p in both groups before achievement target hemoglobin 110 g/l, then was support phase ofanemia treatment during 6 months with hemoglobin target 100g/l to 120 g/l. Next 6 months patients were switched to darbepoetin alfa. Results. It is investigated optimization of anemia correction with long action ESP in patients on HD and HDF. It is revealed a tendency to decrease treatment cost with pegylated erythropoietin–p compared to darbepoetin alfa (1965,13±250,69 vs 2117,39±147,59 Gr/mth) and HDF group compared HD group with pegylated erythropoietin–p (1983,9±345,9 vs 1950,69±367,1 Gr/mth). Treatment with darbepoetin alfa associated with higher hemoglobin variability compared with pegylated erythropoietin–p. Conclusion. The result of our investigation lead to prove some hope to optimization of anemia treatment in patients with CKD Vst. On hemodialysis, but to have statistically reliability we need lager patients groups.
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