Hyperuricemia (HU) is usually considered as a risk factor for gout, and, even being without arthritis, it can be associated with a large number of comorbid conditions, especially with kidney diseases. The results of representative studies and meta-analyses demonstrate the relationship between HU and development of progressive kidney diseases.

The traditionally discussed complex mechanisms of renal injury, induced by HU, include direct renal damage by monosodium urate (MSU) crystals, oxidative stress and endothelial dysfunction summarized in inflammatory response and resulted in glomerular and tubulointerstitial fibrosis. The key element, which triggers the inflammation, is activation of the cryopyrin inflammasome producing interleukin-1 at high level. Not only crystals although soluble UA could activate the inflammasome. Therefore, HU is to be considered as the autoinflammatory disease.

The data for the evolution of UA metabolism in animals and pathways of its intracellular formation suggest, that it is not the HU, but the intracellular hyperconcentration of uric acid (hyperuricocytosis) triggers "alarm signal" for the autoinflammatory reactions; morover, HU resulted from hyperuricocytosis is only a marker of already realized damage. Being on this position means to reconsider approaches to therapy focusing primarily on anti-inflammatory treatment (colchicine and/or interleukin-1 inhibitors) then urate-lowering strategy.

Further study of the molecular mechanisms of HU and associated inflammation is needed to prove the hypothesis given.

The number of patients with chronic kidney disease (CKD) is rising rapidly worldwide, making it a major public health concern. CKD is associated with geriatric syndromes such as frailty, sarcopenia, malnourishment, reduced mobility and falls, cognitive impairment and depression. Despite their prevalence, these syndromes often remain undiagnosed, leading to functional dependence, reduced quality of life, increased hospitalizations and higher risk of mortality.

Progression of CKD results in functional limitations and severe disability, significantly diminishing quality of life, and underscoring the need for rehabilitation strategies – particularly in elderly patients with multiple comorbidities. Assessing functional status is especially important because initiating renal replacement therapy in the end-stage CKD may further functional capacity or even reduce survival in frail elderly adults.

Functional status in elderly and very old patients refers to the ability to independently perform daily activities, use household appliances, maintain personal hygiene and a safe living environment, and manage personal finances. Rehabilitation programs for patients with CKD and acute renal injury (AKI) should include physical activity and nutritional support, which may improve functional independence and daily activity in older adults. Elderly patients recovering from AKI often experience a decline in the quality of life and progression of frailty; in such, rehabilitation is essential for maintaining functional status, although it is more challenging.

Rehabilitation should be tailored to the individual needs of patients with CKD within a holistic framework that accounts for the degree of renal impairment, complications, and comorbidities. An interdisciplinary care team can be more effective than a conventional, disease-focused approach. This article presents recommendations for interventions aimed at preserving age-related frailty and other geriatric syndromes, such as falls and sarcopenia, in elderly and very old patients with chronic kidney disease.

The aim of this retrospective study was to comparatively analyze the clinical course and outcomes of aHUS with genetic complement abnormalities using both our own data and published literature.

Materials and methods. This retrospective study included 55 patients with aHUS (mean age 36.4±8.9 years, 56% male, 44% female) treated between January 2014 and August 2024 at the Moscow Scientific and Practical Center of Nephrology and Pathology of Transplanted Kidney of Moscow City Hospital No 52.

Results. Genetic abnormalities were identified in 61% of patients with aHUS. The most frequently detected variants were CFHR3/CFHR1 (29%), C3 (20%) and CFH (15%). Patients with and without genetic mutations did not differ significantly in sex, age, presence of the full TMA triad, malignant arterial hypertension (MAH), or extrarenal manifestations (р>0.05). Cardiac involvement was more common in patients with CFH variants (24%), and intestinal involvement was more frequent in patients with CFHR3/CFHR1 (56%); however these differences did not reach statistical significance (р>0.05). Five-year renal survival did not differ significantly between patients with or without genetic mutations (50% vs. 65%, respectively, р=0.413), or depending on the presence of MAH (38% vs. 64%, р=0.08) or extrarenal manifestations (43% vs. 64%, р=0.17). All patients with CFH mutation experienced loss of renal function within 5 years despite treatment with eculizumab. A significant improvement in renal survival was observed only in patients who initiated eculizumab therapy within first month of disease onset, compared with those who started treatment after a month or later (89% vs. 11%, respectively, р=0.0001). The five-year mortality rate among patients with aHUS was 7%. Mortality did not differ significantly based on the presence of genetic abnormalities (0% vs. 16%, р=0.295), MAH (33% and 6%, р>0.5) or extrarenal manifestations (14% vs. 0%, р=0.451).

Conclusions. Demographic and clinical characteristics did not differ significantly between patients with or without complement-related genetic abnormalities. A pronounced decrease in renal survival was observed found in patients with CFH mutations compared with whose carrying CFHR1/CFHR3 or without genetic mutations. Five-year renal survival and mortality rate were not significantly associated with other genetic variants, MAH, or extrarenal involvement. Early initiation of eculizumab therapy – within the first month after disease onset – markedly improved renal outcomes and reduces mortality.

Introduction. Kidney replacement therapy – primarily maintenance hemodialysis (MHD) – has enabled patients with end-stage kidney disease to survive for decades despite the loss of kidney function. Consequently, mortality in this population is now largely driven by other causes, including cardiovascular disease, infections, including sepsis, and cancer. Risk factors for with sudden cardiac death (SCD) in patients receiving MHD only partially overlap with those in the general population: renal failure and hemodialysis significantly increase the risk of SCD compared with individuals who have preserved renal function.

The aim of our study was to identify a possible predictor phenotype for SCD in patients undergoing MHD. We analyzed the impact of echocardiographic (EchoCG), electrocardiographic (ECG), and laboratory parameters on overall and cardiac five-year survival in prospective single center patients cohort (n=212) undergoing MHD from 2001 till 2025.

Results: data from 14 deceased patients (31.1% of all cardiac deaths) met the criteria for non-dialytic SCD. We identified clinical profile characteristics of patients who experienced SCD during long-term MHD. The only echocardiographic parameter at baseline differed significantly in the SCD group was the end-diastolic volume (EDV). The median EDV in patients with SCD, regardless of left ventricle ejection fraction (LVEF), was markedly higher than in patients in other groups: 182.8 (144.9-226.2) ml in the SCD group (n=14), 101.0 (75.0-129.3) ml in the reduced LVEF group (n=52), 104.1 (101.2-167.0) ml in the other causes group (n=45), and 114.2 (81.7-140.5) ml in currently living patients (n=99, р=0.007). Compared with patients who died from other causes, those with SCD were younger, had LV dilation, and a relatively short dialysis vintage. Survival was particularly poor in SCD patients with LVEF <40%. Patients undergoing MHD who are under 55 years of age, had increased EDV (especially when accompanied by reduced LVEF), and have a short dialysis history should be considered at elevated risk for SCD on MHD.

Conclusion: the results of this study indicate that patients younger than 55 years, with a with a relatively short dialysis history and left ventricular dilation, especially when LVEF is reduced, carry a higher risk of SCD on MHD.

The aim of this study was to assess the frequency of thrombocytopenia and its clinical significance – including bleeding episodes and the feasibility of prescribing antithrombotic therapy when indicated – in patients receiving post-dilution hemodiafiltration (HDF).

Materials and methods. In this 13-month prospective study, 193 patients (55.4% male) who had been receiving post-dilution HDF for at least 6 months were enrolled. The minimum follow-up duration was 6 months, and the maximum was 13 months. Patients were divided into groups: those without thrombocytopenia (n=102) and those with persistent thrombocytopenia (n=45), defined as platelet count reduction in more than 50% of monthly measurements; these groups formed the basis of the primary analysis. Additionally isolated episodes of thrombocytopenia (<50% of observations), the relationship between mean platelet count and clinical-laboratory parameters, antithrombotic therapy, and the frequency of hemorrhagic complications were evaluated.

Results. Thrombocytopenia occurred in 47.2% patients (at least one episode) and was persistant in 23.3%. Most cases were mild (80%) or moderate (13.3%); severe thrombocytopenia was rare (1.6%). Antithrombotic therapy was prescribed in 29.5% of patients. Minor bleeding events occurred in 3% of patients; most of whom were receiving antithrombotic therapy and had thrombocytopenia at the time of the episode. No significant differences were observed in the frequency of antithrombotic therapy prescription between the patients with and without persistent thrombocytopenia, or between those with mild versus moderate thrombocytopenia (p>0.05). Mean platelet count was not associated with the type or dose of anticoagulant used during HDF (p>0.05). Significant associations (p<0.05) were identified between platelet counts and several hematological, iron-status, nutritional, inflammatory (C-reactive protein), and HDF-related parameters (effective infusion volume and mean filtration fraction).

Conclusion. Thrombocytopenia is common in HDF patients (23.3-47.2%) but is typically mild to moderate in severity. Antithrombotic therapy administered outside HDF sessions did not influence the development or severity of thrombocytopenia. In this study, persistent mild-to-moderate thrombocytopenia had no significant clinical impact on bleeding risk and likely should not preclude the prescription of indicated antithrombotic therapy. Nonetheless, when initiating such therapy to dialysis patients, clinicians should carefully balance its benefits against potential risks, including bleeding, particularly in those with thrombocytopenia. The observed associations variants warrant further investigation.

Native arteriovenous fistula (AVF) remains the gold standard for permanent vascular access in hemo­dialysis patients with end-stage renal disease (ESRD). However, AVF thrombosis is a common and serious complication that leads to access loss and increases the risk of infections and mortality due to the need for central venous access implantation. This highlights the necessity for effective and safety treatment methods. Endovascular techniques, particularly balloon-assisted thrombolysis, represent a promising approach to this problem.

Objective: To evaluate the immediate and long-term outcomes of balloon-assisted thrombolysis in patients with thrombosed native AVF.

Materials and methods: A retrospective analysis was performed on data from 34 ESRD patients who underwent endovascular treatment for native AVF thrombosis between 2020 and 2023 was conducted. Patency rates were assessed using the Kaplan-Meier method. Statistical analysis included calculation of median primary and primary-assisted patency with 95% confidence intervals (CI).

Results: The overall primary patency was 11.5 (95% CI [5.19, 8.48]) months. Forearm AVFs demonstrated superior primary patency at 13.0 months (95% CI [5.38, 10.53]) compared with 11.0 months (95% CI [4.08, 8.79]) for upper arm AVFs. The technical success rate was 97%. Primary-assisted patency at 6, 10, and 12 months was 97%, 64%, and 50%, respectively. By 12-month, all upper arm AVFs had lost patency, whereas only 21% of forearm AVFs had thrombosed (p<0.001). Intraoperative complications included venous perforation (15%) with complete resolution of residual thrombi (32%), with complete resolution of residual thrombi by the 4th week of follow-up. No major complications, such as pulmonary embolism or distal arterial embolism, were recorded.

Conclusions: Balloon-assisted thrombolysis is a highly effective and safe method for restoring patency in thrombosed native AVFs, achieving a high technical success rate. Forearm access location is an important prognostic factor and is associated with significantly better long-term primary-assisted patency outcomes compared with upper arm fistulas.

Introduction. Increased physical activity in patients with chronic kidney disease (CKD) is associated with numerous proven benefits. However, physical rehabilitation programs are rarelu integrated into standard clinical practice, and the reasons for this remain unclear. The study aimed to explore nephrologist’s opinions regarding exercise and physical activity in patients with CKD.

Methods. An anonymous survey was conducted among nephrologists working in outpatient dialysis units in the between May and July 2025.

Results. A total of 98 physicians from dialysis centers participated in the survey. The average age of respondents was 42(10) years, and their work experience was 14(9) years. Respondents themselves engaged in physical activity infrequently (median 1 time per week (<1 – 2‑3 times), yet 52% regularly ask their patients about activity levels, and 45% provide regular recommendations. Sixty percent of centers lacked physical rehabilitation programs, while 24% offered them for hemodialysis patients. Respondents identified the main barriers to program development as lack of funding (58%), transportation issues (44%), and lack of patients motivation (36%); less frequently, barriers included the attitude of the center management (31%) and staff (29%). The most recommended activities included walking (97%), swimming (67%), cycling (46%), flexibility exercises (39%), and coordination (29%). Regarding guidance, respondents believed physiotherapists (80%), nephrologists (56%), psychologists (34%), nutritionists, and nurses (27% each) should advise patients on physical activity, with 19% suggesting all listed specialists. Only 39% fully agreed that regular exercise is beneficial for patients with advanced stages of CKD and those on renal replacement theraphy, with most doubts (15%) arising in the predialysis stages.

Conclusions. There is a critical shortage of exercise programs for patients with CKD. Key obstacles include limited interest from staff and management of the centers, insufficient funding and gaps in knowledge about physical rehabilitation. Greater attention to these factors is essential to integrate structured exercise into CKD care.