The review scrutinize the publication of primary and secondary results of one of the largest randomized trial in nephrology EVOLVE, which assessed the effects of treatment with cinacalcet or placebo in 3883 patients with secondary hyperparathyroidism on cardiovascular outcomes with follow-up up period of 5.6 years. Despite neutral results in primary end-point, the series of secondary analyses revealed the possibilities to suggest the ways for improving the efficiency of antihyperparathyroid strategies, which nevertheless require special trails. The improvements in cardiovascular outcomes were observed: (1) while limiting the follow-up period to six months after treatment termination; (2) in patient older than 65 years; (3) while the FGF23 level decreased by >30% during the treatment; (4) while accounting only for "non-atherosclerotic" cardiovascular events; (5) in patients with baseline PTH level below 900 pg/ml; (6) in patients with baseline dialysis shorter then 2 years. The two latter factors indicate a lower probability of the development of autonomous adenomas. The results concerning hypertension and fractures are discussed as well as the dependence of cinalalcet effects from calcium dialysate concentrations and the vitamin D levels or VDRA therapy. The interpretation of EVOLVE results are further complicated due to the difference in protocol defined goals in PTH level (below 300 pg/ml) and target range of PTH, defined in current KDIGO guidelines (both 2009 and 2017 update). The searching of optimal practice of calcimimetics use are being actualized by recent approvement of intravenous drug in the class - etelcalcetide ensuring 100% compliance by route of administration; perhaps, it is the reason for its higher efficiency in head-to-head comparison as well as for higher incidence of side effects frequency - both approximately by 10

This review is devoted to controversial issues of surgical treatment of secondary hyperparathyroidism in patients with the terminal stage of chronic kidney disease (CKD). Data concerning the relevance of a surgical treatment of secondary hyperparathyroidism in patients receiving renal replacement therapy with hemodialysis are presented. Current recommendations about indications for surgical treatment of patients with secondary hyperparathyroidism associated with chronic kidney disease are described. The absence of a single criterion for assessing the effectiveness of surgical treatment of secondary hyperparathyroidism in patients with the terminal stage of CKD is highlighted. Special attention is paid to the outcomes of surgical treatment of secondary hyperparathyroidism, such as hypoparathyroidism, persistence and recurrence of the disease. The problem of the development of the adynamic bone disease after parathyroidectomy in patients with secondary hyperparathyroidism associated with CKD is briefly mentioned. The current data concerning the choice of the optimal scale of the surgical treatment are analyzed. A comparative estimate of the published data and existing views on the parathyroid hormone target level during the operation and in different periods after it is provided. A comparative assessment of intraoperative monitoring of intact parathyroid hormone is given.

Aim. Widely accepted guidelines for anemia correction have not become a standard care because - among other reasons - due to lack of its contemporary confirmation in real practice. The aim of the study was to assess ESA requirements in unselected city dialysis cohort as well as optimal single doses and regimen for planning of ESA supply. Patients and methods. We collected the data concerning anemia correction in 2016 for 1150 patients in 11 dialysis centers (68% of city dialysis cohort) for 12835 patient-months from centers reports, RRT register and data from official ESA distribution system. We evaluated the optimal single doses and ratio between them in specially designed algorithm. Results. The Hb median were 11.1 (10.3÷11.9) g/dl; 60.1% of monthly collected data met the target range10.0÷12.0 g/dl; During 33.2% of period duration patients did not receive ESA including only 3,6% - at Hb<10.0 g/dl, 14,5% - at Hb>12.0 g/dl. The Hb level in patients without ESA was 11.8 (11.0÷12.7) g/dl; with ESA - 10.9 (10.1÷11.5) g/dl. For whole cohort the weekly dose median was 3466 IU, among patients with ESA - 5 250 (3000÷6750) IU. The most frequently used doses were ranges with local maximums 2 500 IU, 5 000 IU and 9-10 000 IU. Conclusion. The single doses 2500 IU and 3000 IU were the most in-demand single doses while applying designed algorithm. The ratio between them could depend on patient cohort feature; in Saint Petersburg, it was 4:1.

Aim. To evaluate the prevalence and clinical features of Fabry disease identified during screening of dialysis patients in Russia. Material and methods. Screening for Fabry disease was performed by measuring the activity of α-galactosidase A enzyme in dried blood spots or plasma by tandem mass-spectrometry in patients treated with hemodialysis. Diagnosis in all patients was confirmed by genetic test. Results. 5572 dialysis patients (3351 males and 2021 females) were screened in the different regions of the Russian Federation. Fabry disease was diagnosed in 20 (0.36%) patients, including 19 males and 1 female aged from 28 to 58 years (median age 42 years). In 6 patients (30.0%) the duration of chronic kidney disease prior to initiation of renal replacement therapy was unknown, while the remaining patients started dialysis within 3 to 13 years (median of 4 years) after proteinuria was detected. In the majority of patients, renal replacement therapy was initiated at the age of 20 to 49 years. Sixteen of 20 patients (80.0%) presented with classic symptoms of Fabry disease from childhood (neuropathic pain in 16, angiokeratoma in 7 and hypohidrosis/anhidrosis in 16). All patients had left ventricular hypertrophy on echocardiography, and 8 (40.0%) patients presented with a history of stroke (one of them died from a recurrent stroke). Conclusion. The majority of dialysis patients with Fabry disease detected by screening had early symptoms from childhood. A higher awareness of the Fabry disease among nephrologists is essential for timely diagnosis.

Aim: economic analysis of the efficiency of medical care of patients with the end-stage renal disease (ESRD) with peritoneal (PD) or hemodialysis (HD), based on a decision analysis model. Methods: the research is based on the methods impact analysis of value for money and Russian federal budget efficiency taking into account prices for dialysis according to the methodical recommendations and rules of the compulsory health insurance (CHI) and current tariffs in six regions of Russian Federation. The budget impact analysis showed that the expansion of the PD program used as the first-line therapy in patients with ESRD is accompanied by savings in public budget 809028021 rubles for the treatment of 28440 patients per year. The overall cost of PD therapy was by 66157 rubles (2%) per a patient lower than the cost of HD therapy. The use of PD in the regions according to the current rates is accompanied by budget savings from 3759929 rubles in the Orenburg region (452 dialysis patients) to 615749884 rubles a year in the Krasnodar region (1837 dialysis patients). Conclusion: the budget impact analysis shows that the use of PD therapy is accompanied by economy of budget funds, as based on rates for carrying out dialysis, established according to methodical recommendations about payment methods of medical care supported by CHI and at the current regional tariffs. It is found that PD in comparison with HD is preferable medical technology from a position of the value for money for current regional tariffs and at the federal rates recommended by CHI.

Aim: five-year analysis of the dynamics of revealing patients with chronic kidney disease (CKD) and state of the renal replacement therapy in comparison with neighbor regions (Ekaterinburg), Privolzskii Federal Region and whole Russian Federation, evaluation of possible influence of the regional nephrology center and registry of such patients. Method: comparative analysis of appropriated statistical data. Results and main conclusions. The state of renal replacement therapy (RRT) in Orenburg Region corresponds to its average level in Russian Federation with higher use of peritoneal dialysis and marked delay in kidney transplantation. The activity of region nephrology center and registry of patients with CKD revealed by doctors of this center was accompanied by rapid increase in the number of patients who received renal replacement therapy and a substantial increase in the number of patients with functioning renal graft. Further improvement of the activity of regional the nephrology center should involve an improvement of work with physicians in the region in revealing patients with CKD and risk factors of its development, especially with those with the second stage of disease when conservative kidney protection is rather effective.

Clinically relevant contrast-induced acute kidney injury (CI-AKI) is a severe complication of interventional contrast-based procedures of all kinds. It is linked to high morbidity, mortality, social and financial losses. Acute renal damage after coronary angiography or percutaneous coronary intervention may occur in 1-2% cases in general population or in more than 50% of cases with high risk of developing CI-AKI. It is very important to identify existing compromised renal function in a high-risk patient, as it is a major and frequent CI-AKI predisposing factor. There are novel biomarkers with rapid or nearly instant response to acute subclinical contrast-induced renal damage, which are highly valuable in CI-AKI diagnosis and for this reason desire deeper clinical research. Despite a number of controversies, prophylactic and therapeutic measures are practically the same in a vast majority of guidelines. Intravenous 0.9% NaCl solution remains one and only proved measure in CI-AKI prophylaxis and therapy, while the use of other pharmacological approaches still needs more relevant prospective clinical research. The aim of this paper was review contemporary, CI-AKI-devoted, evidence-based data.