Arterial hypertension is the important reason of the morbidity and mortality of the patients with chronic kidney disease. The aim of this study was to estimate the feature of the arterial hypertension, vasomotor form endothelial dysfunction and level of VCAM1 at patients with chronic kidney disease at groups with achievement and not achievement target arterial pressure. At the moment of the survey the target arterial pressure was achieved at 70 (1 group) and not achieved at 31 patients (2 group). During investigation it was applied the complex of biochemical, immune-enzyme and instrumental methods. The vasomotor form of endothelial dysfunction was detected at all of patients. The improvement of endothelium-dependent vasodilatation was defined at patients with achieved target arterial pressure. The VCAM1 concentration was elevated only at the patients 2 group. This group was differ from the 1 group with more high arterial pressure, left ventricular hypertrophy, atrium enlargement, complex intima-media enlargement, decrease glomerular filtration rate. It was made the conclusion that achievement target arterial pressure facilitate the correction of vasomotor form of endothelial dysfunction.
Aim.The optimal time for initiating of chronic dialysis remains unknown. The scale for mortality risk assessment could help in decision-making concerning dialysis start timing.Methods.We randomly divided 1856 patients started dialysis in 2009–2016 into developmental and validation group (1:1) to create and validate scoring system «START» predicting mortality risk at dialysis initiation in order to fi nd unmodifi able and modifi able factors which could help in the decision-making of dialysis start. In the series of univariate regression models in the developmental set, we evaluated the mortality risk linked with available parameters: age, eGFR, serum phosphate, total calcium, hemoglobin, Charlson comorbidity index, diabetes status, urgency of start (turned to be signifi cant) and gender, serum sodium, potassium, blood pressure (without impact on survival). Similar hazard ratios were converted to score points.Results.The START score was highly predictive of death: C-statistic was 0.82 (95% CI 0.79–0.85) for the developmental dataset and 0.79 (95% CI 0.74–0.84) for validation dataset (both p < 0.001). On applying the cutoff between 7–8 points in the developmental dataset, the risk score was highly sensitive 81.1% and specifi c 67.9%; for validation dataset, the sensitivity was 78.9%, specifi city 67.9%. We confi rmed the similarity in survival prediction in the validation set to developmental set in low, medium and high START score groups. The difference in survival between three levels of START-score in validation set remained similar to that of developmental set: Wilcoxon = 8.78 (p = 0.02) vs 15.31 (p < 0.001) comparing low–medium levels and 25.18 (p < 0.001) vs 39.21 (p < 0.001) comparing medium–high levels.Conclusion.Developed START score system including modifi able factors showed good mortality prediction and could be used in dialysis start decision-making.
Нарушения эндотелийзависимой вазодилатации и маркеры оксидативного стресса при хронической болезни почек I стадии 1 Федеральное государственное бюджетное образовательное учреждение высшего образования «Первый Санкт-Петербургский государственный медицинский университет имени академика И. П. Павлова»
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.