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Том 5 №1 2003 год - Нефрология и диализ

Проблема сердечно-сосудистых заболеваний при хронической почечной недостаточности


Томилина Н.А. Волгина Г.В. Бикбов Б.Т. Ким И.Г.

Аннотация: Проблема кардиоваскулярной патологии при хронической почечной недостаточности (ХПН) является одной из наиболее актуальных в современной нефрологии. Это определяется тем, что сердечно-сосудистые заболевания (ССЗ) при терминальной ХПН возникают в среднем в 20-35 раз чаще, чем в общей популяции, и показатели кардиоваскулярной летальности в группах, сопоставимых по полу и возрасту, многократно превышают таковые в общей популяции [18, 23, 24, 51, 77, 86, 88, 117]. Так, у больных в возрасте 25-34 лет они в 120 раз выше, чем в той же возрастной группе в общей популяции. Для возрастной группы 55-64 лет это соотношение составляет 1:15, а для больных старше 85 лет - 1:3 [135]. Только патология сердца составляет в общей структуре смертности диализных больных 47% [150]. По данным Московского регистра больных с ХПН, удельный вес кардиоваскулярной летальности достигал в 1995-2000 гг. 42,3% в группе леченных перитонеальным диализом и 45,5% в популяции гемодиализных больных (рис. 1). После трансплантации почки ССЗ сохраняют свое лидирующее значение в структуре летальности. По данным Ojo и соавт. [113], они составляют 36% среди причин смерти реципиентов с функционирующим трансплантатом. По нашим собственным данным, основанным на 7-летних наблюдениях 314 пациентов, оперированных в 1995-1996 гг., величина этого показателя достигает 41%

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Ключевые слова: хроническая почечная недостаточность, сердечно-сосудистые заболевания, факторы риска, ишемическая болезнь сердца, гипертрофия миокарда, фосфорно-кальциевый обмен

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