On behalf of the World Kidney Day Steering Committee * * Members of the World Kidney Day Steering Committee are: Philip Kam Tao Li, Guillermo Garcia-Garcia, William G. Couser, Timur Erk, Julie R Ingelfinger, Kamyar Kalantar-Zadeh, Charles Kernahan, Charlotte Osafo, Miguel C. Riella, Luca Segantini, Elena Zakharova Abstract World Kidney Day 2016 focuses on kidney disease in childhood and the antecedents of adult kidney disease that can begin in earliest childhood. Chronic kidney disease (CKD) in childhood differs from that in adults, as the largest diagnostic group among children includes congenital anomalies and inherited disorders, with glomerulopathies and kidney disease in the setting of diabetes being relatively uncommon. In addition, many children with acute kidney injury will ultimately develop sequelae that may lead to hypertension and CKD in later childhood or in adult life. Children born early or who are small for date newborns have relatively increased risk for the development of CKD later in life. Persons with a high-risk birth and early childhood history should be watched closely in order to help detect early signs of kidney disease in time to provide effective prevention or treatment. Successful therapy is feasible for advanced CKD in childhood; there is evidence that children fare better than adults, if they receive kidney replacement therapy including dialysis and transplantation, while only a minority of children may require this ultimate intervention. Because there are disparities in access to care, effort is needed so that those children with kidney disease, wherever they live, may be treated effectively, irrespective of their geographic or economic circumstances. Our hope is that World Kidney Day will inform the general public, policy makers and caregivers about the needs and possibilities surrounding kidney disease in childhood.

Russian national clinical recommendations for diagnosis and treatment of anemia in chronic kidney disease are renewal of the national recommendations issued in 2006 by Anemia Working Group previously and accumulate information from large multicenter clinical trials and re-analysis and meta-analysis of data published until December 2015. The working group considered statements and rationales of KDIGO (2012), other national guidelines and position statements as well as Russia population feature and real practice conditions. The target level for hemoglobin is defined as 10.0-12.0 g/dl. The groups of patients, which can benefit with hemoglobin level close to lower and upper border of the target range are described. The algorithms of patient evaluation and therapy are recommended as well as the evaluation of non-responders. First line therapy in most cases is iron; the erythropoietin (EPO) dose escalation in resistant cases should be limited. The exceeding of weekly dose of 12,000 IE rarely leads to hemoglobin increase but extends the risks linked to EPO therapy. Blood transfusion is indicated in very limited number of conditions.

Central vein stenosis is a reason of dysfunction of vascular access in patients on chronic hemodialysis. This disease is widespread. A question how to treat these patients is open. The main reason of central vein stenosis is the use of hemodialysis catheters. Therefore, the only way to prevent a damage of central vein is the forming of arteriovenous fistula before start of chronical hemodialysis instead of using of hemodialysis catheters. As a rule, clinical signs (edema of ipsilateral upper extremity and breast, pain in an arm and the development of subcutaneous collaterals) appear after creation of fistula or graft. During a dialysis session, there are high venous pressures, increased recirculation and increased hemostasis time with the removal of the dialysis needles. Nowadays, there is no effective non-surgical method of treatment. The most informative methods of diagnosis are angiography and MSCT venography. Despite of high incidence of restenosis, endovascular intervention (balloon angioplasty and stenting) is the preferable method of correcting central vein stenosis to surgical one (various methods of bypass grafting). The article provides is some information about etiology, prophylaxis, diagnosis and treatment of this condition.

Aim: To compare impact of parathyroidectomy (PTE) and conservative therapy (CT) on laboratory markers of CKD-MBD and survival in severe refractory secondary hyperparathyroidism. Methods: In a representative cohort of dialysis patients in St. Petersburg we compared the dynamics of average annual values of basic laboratory markers of mineral and bone metabolism and the survival rate between the groups of patients with resistant severe secondary hyperparathyroidism with performed PTE (84), and continued to receive CT (105). Groups were significantly different only in the duration of dialysis therapy and the level of serum calcium. Results: PTE resulted in a statistically significant reduction in level of PTH (1166±527 to 199±207 pg/ml), calcium (2.49±0.20 to 2.18±0.29 mmol/l) and phosphorus (2.46±0.50 to 1.96±0.58 mmol/l) with high frequency of hypocalcemia (44%) and hypoparathyroidism (52%) during the first year after surgery. The fraction of patients with phosphate concentration within target range increased from 4 to 46%. In CT group, a reduction of phosphate level (5%) was the only significant change in a laboratory parameter during the first year. The survival rate in PTE group was significantly higher. There were two significant factors, which determined the survival difference in Cox multivariate model: age (increased risk of death by 2.1% per one year) and PTE (reducing the risk of death by 2.3 times). Conclusions: In current clinical practice parathyroidectomy seems to be preferred method for therapy of resistant severe secondary hyperparathyroidism (PTH levels higher 800 pg/ml for six months) and can significantly reduce the risk of death in this group.

Background: In the last decade, the results of many studies have shown the successful use of rituximab (RTX) in the treatment of children with steroid-dependent nephrotic syndrome (SDNS), which relapses despite of the use of conventional immunosupressive agents. The aim of our study was to evaluate the efficacy and safety of rituximab therapy in children with refractory SDNS. Materials and methods: The group of patients included 9 children (median age 11.5 years). All patients were dependent on high doses of prednisolone: the median 0.46 (range 0.32-0.78) mg/kg/day, revealed a high incidence of relapses NS 3.0 (1.8-6.0) times/years, and had clinical signs of severe steroid toxicity. The children received one to four intravenous infusions weekly of 375 mg/m2 RTX during the first course. Results: Within 6 months and 12 months after an initial treatment with RTX: none of the children developed relapses of NS; steroids have been discontinued in 33.3% and 66.6% of patients, respectively; in other children the dose of prednisone was significantly reduced to 0.095 (0.04-0.25) mg/kg/day (p < 0,01) and 0.04 (0.02-0.04) mg/kg/day (p < 0,01). All five patients with long-term follow-up required repeated courses of RTX. The maintenance therapy of low-dose prednisone (median 0.04 mg/kg/day) was reintroduced in 80% of patients showing a significant reduction in the frequency of relapses of NS (median 0.4 times/year). Cyclosporine A have been discontinued in all patients. Conclusion: The use of Rituximab leads to a significant reduction in the frequency of relapses, as well as a significant steroid-sparing and cyclosporine-sparing effect in patients with refractory SDNS.

Aim: Pulmonary hypertension (PH) is a risk factor for mortality and cardiovascular events in hemodialysis patients. The aim of this study was to investigate cardiac remodeling and pulmonary blood pressure during a year-long hemodialysis treatment. Methods: Fifty patients (F-31, M-19, mean age 55±12 years) were studied in the beginning of hemodialysis and after a year. Echocardiography and Doppler echocardiography were performed. Pulmonary hypertension was diagnosed according to European Society of Cardiology Guidelines. Results: Pulmonary hypertension was revealed in 29 (58%) patients. After a year of dialysis treatment, the left ventricular mass decreased from 159.1±35.8 to 129.1±42.2 g/m2 (р=0.04) and systolic pulmonary blood pressure decreased from 46.3±16.1 to 40.4±11.7 mmHg (р=0.01). There is no relationship between the pulmonary blood pressure and blood flow in arteriovenous fistula (r=0.12, р=0.3). Pulmonary pressure correlated negatively with the left ventricular ejection fraction. Conclusions: Pulmonary hypertension in hemodialysis patients is associated with the left ventricular hypertrophy and systolic and diastolic dysfunction of left ventricular. After a yearlong hemodialysis treatment, a regress in left ventricular hypertrophy and a partial decrease in pulmonary blood pressure were observed.

Modern data on cardiovascular (CV) morbidity and mortality in patients on chronic hemodialysis (CHD) are described. According to published data, approximately one of five patients die by the end of the first year of CHD. High CV mortality of dialysis population is a consequence of a combination of traditional and non-traditional risk factors. Non-traditional risk factors are represented by set of toxico-metabolic and hemodynamic effects of renal damage load on myocardium and CHD per se. For a cardiologist, CHD-associated CV risk factors are the subject of particular interest. Among them hemodynamic syndialysis stress, CHD-induced myocardial ischemia, overload, intra/post-dialysis hypotension, high output heart failure and dynamic intraventricular obstruction should be mentioned. All these phenomena cause direct myocardial injury and aggravation of heart failure. The problems listed dictate the need to develop a definite methodology of an initial assessment and follow up of cardiac status of CHD-patients. Authors propose interdisciplinary approaches to the above-mentioned problems.

Arteriovenous fistula is the main access for chronic hemodialysis. A functioning arteriovenous access for hemodialysis is an essential hemodynamic factor that contributes to additional load on the heart. Rare long-term complication of permanent vascular access in patients receiving hemodialysis is chronic heart failure. In such cases, heart failure is characterized by a high minute cardiac output and traditional medical therapy is often not effective. In order to avoid an unfavorable outcome, surgical correction of blood flow through the arteriovenous fistula is required. The article provides a brief overview and analysis of existing surgical techniques for the treatment of excessive shunt of blood flow into the right atrium in patients receiving hemodialysis with clinical manifestations of chronic heart failure. The authors propose a new surgical method of the correction of excessive blood flow in the fistulas without the disadvantages of known ones. The effectiveness of this method was assessed using studies of cardiac hemodynamics and blood flow in the vessels by echocardiography and color Doppler mapping. Our attention was focused on the anatomical and functional state of the arterial and venous segments of an arteriovenous fistula. The amount of shunt blood flow before and after surgery was measured.