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Introduction: A factor that worsens the course of coronary heart disease (CHD) in patients with type 2 diabetes mellitus (DM2) is cardiovascular autonomic neuropathy (CAN), in which the risk of sudden death increases fivefold. The prevalence of CAN in patients with both CHD and DM2 may reach 60%. Classic cardiovascular tests (CCT) do not permit identification of CAN at the preclinical stage. A modern method of treatment for DM2 uses sodium-glucose co-transporter 2 inhibitors, which have confirmed cardioprotective effects. Aim: To analyze the prevalence of alterations of arterial pressure variability (APV) and of heart rhythm variability (HRV) in patients with both CHD and DM2 and the effect of empagliflozin on these parameters. Materials and methods: A total of 210 patients aged 64.5 6.7 years (103 men) with both CHD and DM2 were examined (group1). Anthropometric and biochemical parameters were analyzed, electrocardiogram and arterial pressure were monitored daily, and CCT was performed. For comparison, 64 patients with CHD with no alterations in the carbohydrate metabolism were examined (group2, n=64, aged 66.4 2.3 years). Further, among patients in group1, patients with impaired HRV and APV were selected, but they had CCT scores 4.0, and they were divided into group1G (n=22) where empagliflozin was added (1025 mg/day) and group1C (n=20) where the previous therapy was continued. Results: CAN was detected in 22% of patients with CHD and DM2, and all patients had impaired HRV and ADV. Deviations of HRV and APV parameters with normal CCT scores ( 4.0) were detected in 43% of the patients. Within 6 months of treatment with empagliflozin, the HbA1c level decreased from 8.38% 0.56% to 6.9% 0.26% (p 0.05); in the groupwithout empagliflozin treatment, it decreased from 8.28% 0.32% to 7.30% 0.29% (p 0.05). In the empagliflozin group, the average heart rate per day decreased from 86.7 2.4 to 76.7 2.1 beats/min (p 0.05), the circadian index increased from 1.19 0.02 to 1.30 0.01 (p 0.05), the SDNN increased from 106.1 2.21 to 114.03 2.34 ms (p 0.05), and the systolic arterial pressure variability index decreased from 22.9% 1.7% to 16.4% 1.9% at daytime (p 0.05) and from 16.8% 2.2% to 12.3% 2.6% at nighttime (p 0.05). Conclusion: The identified alterations of HRV and APV parameters may be manifestations of CAN, and CCT score 4.0 may indicate the preclinical stage. Positive dynamics of HRV and APV was recorded with empagliflozin therapy, which improved the functional condition of the autonomic nervous system.
Introduction: A factor that worsens the course of coronary heart disease (CHD) in patients with type 2 diabetes mellitus (DM2) is cardiovascular autonomic neuropathy (CAN), in which the risk of sudden death increases fivefold. The prevalence of CAN in patients with both CHD and DM2 may reach 60%. Classic cardiovascular tests (CCT) do not permit identification of CAN at the preclinical stage. A modern method of treatment for DM2 uses sodium-glucose co-transporter 2 inhibitors, which have confirmed cardioprotective effects. Aim: To analyze the prevalence of alterations of arterial pressure variability (APV) and of heart rhythm variability (HRV) in patients with both CHD and DM2 and the effect of empagliflozin on these parameters. Materials and methods: A total of 210 patients aged 64.5 6.7 years (103 men) with both CHD and DM2 were examined (group1). Anthropometric and biochemical parameters were analyzed, electrocardiogram and arterial pressure were monitored daily, and CCT was performed. For comparison, 64 patients with CHD with no alterations in the carbohydrate metabolism were examined (group2, n=64, aged 66.4 2.3 years). Further, among patients in group1, patients with impaired HRV and APV were selected, but they had CCT scores 4.0, and they were divided into group1G (n=22) where empagliflozin was added (1025 mg/day) and group1C (n=20) where the previous therapy was continued. Results: CAN was detected in 22% of patients with CHD and DM2, and all patients had impaired HRV and ADV. Deviations of HRV and APV parameters with normal CCT scores ( 4.0) were detected in 43% of the patients. Within 6 months of treatment with empagliflozin, the HbA1c level decreased from 8.38% 0.56% to 6.9% 0.26% (p 0.05); in the groupwithout empagliflozin treatment, it decreased from 8.28% 0.32% to 7.30% 0.29% (p 0.05). In the empagliflozin group, the average heart rate per day decreased from 86.7 2.4 to 76.7 2.1 beats/min (p 0.05), the circadian index increased from 1.19 0.02 to 1.30 0.01 (p 0.05), the SDNN increased from 106.1 2.21 to 114.03 2.34 ms (p 0.05), and the systolic arterial pressure variability index decreased from 22.9% 1.7% to 16.4% 1.9% at daytime (p 0.05) and from 16.8% 2.2% to 12.3% 2.6% at nighttime (p 0.05). Conclusion: The identified alterations of HRV and APV parameters may be manifestations of CAN, and CCT score 4.0 may indicate the preclinical stage. Positive dynamics of HRV and APV was recorded with empagliflozin therapy, which improved the functional condition of the autonomic nervous system.
Purpose. To evaluate the clinical and economic efficacy of the drug complex of beta-iron (III) oxyhydroxide, sucrose, and starch (Velphoro) in comparison with sevelamer in patients with stage 5 chronic kidney disease (CKD) receiving phosphate binding therapy during renal replacement therapy (RRT) in the conditions of the healthcare system of the Russian Federation. Materials and methods. An analytical decision-making model, which allows estimating the costs of managing patients with stage 5 CKD receiving phosphate binding therapy along with RRT, was built in MS Excel. The model included the costs of phosphate binding therapy with beta-iron (III) oxyhydroxide-sucrose-starch complex or sevelamer, as well as the cost and incidence of non-RRT hospitalizations in patients with CKD. The frequency of hospitalizations was determined according to a retrospective analysis of the data from End Stage Renal Disease Seamless Care Organizations (ESCOs), USA (2016-2018). The potential economic impact of using comparison strategies was calculated in 19,617 estimated patients with stage 5 CKD receiving RRT and phosphate binders. Results. The use of beta-iron (III) oxyhydroxide, sucrose, and starch complex in comparison with sevelamer is associated with a reduction in costs by 10,222 rubles or by 7.4 % on average per patient, which allows fully reimbursing the costs of more expensive drug therapy (the difference in costs minus the cost of drug therapy is 896 rubles in favor of the beta-iron (III) oxyhydroxide, sucrose, and starch complex), and reducing the number of hospitalizations in the target population by more than 6,000 cases. When used in the target cohort of patients, savings will amount to 200.5 million rubles (17.6 million rubles minus the difference in the cost of drug therapy). Conclusion. The use of beta-iron (III) oxyhydroxide, sucrose, and starch complex in patients with CKD during the RRT is clinically and economically feasible, as it allows reducing the number of hospitalizations and is characterized by fewer pills taken daily, reducing the overall costs of patient treatment.
THE AIM: to study the relationship of blood sclerostin with clinical parameters and its influence on the probability of detection of cardiovascular calcification in patients with CKD C5D.PATIENTS AND METHODS. The study was a single-stage, cohort study involving 84 patients with stage 5D CKD who received hemodialysis therapy, including 40 (47.6 %) female patients and 44 (52.4 %) male patients. The average age was 55.6±14.9 years. The examination included, in addition to routine studies, echocardioscopy with an assessment of calcification of the heart valves, abdominal radiography in the lateral projection with an assessment of aortic calcification, analysis of indicators that characterize phosphorus-calcium metabolism (serum sclerostin levels, 1.25(OH)D, FGF-23, A-klotho, PTH, P and Cа blood). Statistical analysis was performed using the computer program STATISTICA 12.6 (StatSoft Inc., USA).RESULTS. It was shown that the level of sclerostin is higher in the elderly, as well as those who have signs of hypoproteinemia and hypoalbuminemia, indirectly indicating the presence of protein-energy deficiency. There is an Association of blood sclerostin with FGF-23 and Alpha-klotho. From the point of view of the probable influence on the processes of cardiovascular calcification, this relationship shows its unidirectionality. Increased blood sclerostin levels have been shown to be associated with the risk of detecting signs of cardiovascular calcification. Moreover, it is shown that the higher the level of sclerostin in the blood, the more pronounced the degree of this calcification. Along with the increase in the level of sclerostin, the ability of a deficit of 1.25(OH)D to lead to the development of calcification was confirmed.CONCLUSION. A high level of sclerostin in the blood serum of more than 92.5 pmol / l in patients with CKD C5D increases the risk of detecting signs of cardiovascular calcification (calcification of the aortic wall and heart valves). An increase in sclerostin levels occurs in conjunction with an increase in FGF-23 and a decrease in 1.25(OH)D
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