Patients who require long-term hemodialysis need long-term vascular access. An eight year retrospective review was undertaken to evaluate the patency rates of arteriovenous fistulae in patients with diabetes mellitus. The aim of this study was to compare the patency rates of wrist and elbow fistulae, and to propose the surgical tactics for establishment of adequate permanent vascular access for dialysis in diabetic patients.

The effect of intravenous ”pulse-therapy” with alfacalcidol (ETALPHA) was studied in 16 dialysis SHPT patients. Average doses of ETALPHA depended on the severity of SHPT and ranged from 3 to 9 mg per week. The treatment consisted of several stages and included intravenous and oral therapy with alfacalcidol. The total duration of the study was 11 months. Resolution of SHPT was observed in 2 patients (13%), in 14 patients (87%) a decrease in serum iPTH level was achieved. In those patients with severe SHPT who responded to the treatment serum iPTH decreased by 50% (from 1185,6 ± 374 to 612,2 ± 377 pg/ml, М ± SD). In patients with moderate SHPT serum iPTH level decreased by 63% from the baseline of 623,27 ± 121 to 228,27 ± 123,06 pg/ml. A target iPTH level (<300 pg/ml) was achieved in 3 patients (19%), oversupression of parathyroid hormone production was detected in 3 patients (19%). Normalization of bone formation markers (alkaline phosphatase and bone specific alkaline phosphatase) and of bone resorbtion marker (b-crosslaps) was observed in all patients including those who had progressive increase of the iPTH level. Treatment with alfacalcidol led to normalization of bone resorbtion markers in 12 patients (75%) and of bone formation markers in 13 patients (81%). Conclusion. Intravenous alfacalcidol therapy has advantage over oral treatment because it gives the opportunity to use higher doses of alfacalcidol, which may be needed to control parathyroid glands function, with lower risk of violation of calcium-phosphorus metabolism.

In an one-stage study of 104 patients with chronic renal failure treated with ambulatory peritoneal dialysis (CAPD) we analyzed the incidence of the disease, its severity, structure, and the basic mechanisms of development of malnutrition. The nutritious status of the patient was assessed by a complex method of nutritional assessment. The incidence of malnutrition was 55,8% (33,7% cases of mild malnutrition, 22,1% cases of moderate severity). Malnutrition structure included combined form (53,4% cases), marasmus (43,1%), and kwashiorkor (3,5%). No correlation was found between malnutrition development, and patient age, duration and dose of CAPD, presence of diabetes mellitus or concomitant diseases. Malnutrition development was associated with the onset and/or exacerbation of anemia, decay of residual renal function, inadequate assimilation of nutrients from food, large protein loss through peritoneum, the number of peritonitis the patient had suffered and with systemic inflammation. The significance of protein catabolism rate for defining consumption of dietary protein was not proved.

Cardiovascular comorbidity is an important determinant of outcome of CKD treatment. However the incidence, prevalence and changes over time in cardiac remodeling differ among various populations, at different stages of CKD and vary with renal replacement therapy (RRT) modality. Determination of influencing factors could prevent undesirable progression of the remodeling as well as will help to choose appropriate time and RRT modality in the context of the integrated care. Echocardiographic finding in 96 predialysis, hemodialysis and peritoneal dialysis patients including repeated examinations during one year revealed the prevalence and structure of the cardiac remodeling, its relationship with arterial hypertension, calcium-phosphate disorders, anemia, malnutrition-inflammation syndrome, achieving of volume balance. Usually these relationships are non-linear and this hampers their determination. Moreover, many influencing factors are closely related. Patients with PTH level within target range 150–300 pg/ml demonstrated positive changes in remodeling in repeated examinations compared to patients with lower and higher values. Patients whose hemoglobin often falls below 95 g/l often showed negative changes over time. Due to increased prevalence of the left ventricular hypertrophy among patients on PD in spite of lower degree of arterial hypertension they require more attention during maintaining volume balance and use of peritoneal solutions with glucose polymer.

In 10% of cases Multiple myeloma (MM) begins with severe uremia, thus these patients require renal replacement therapy. We studied 14 patients with newly diagnosed MM. In all these patients the disease debuted with severe stage renal failure. Renal biopsy was performed before chemotherapy with the subsequent light, immunofluorescent and electron microscopy. As a result of the treatment renal function has improved in 4 (28%) patients that allowed us to stop haemodialysis. In other patients after chemotherapy the improvement of renal function has not occurred and haemodialysis has been continued. Study of kidneys biopsies of the patients with MM and severe renal failure in 50% of cases has revealed combined character of renal injury: cast nephropathy and monoclonal light chains deposits, and fibrillar nephropathy. Isolated myeloma nephropathy was diagnosed in 43% of cases. The absence of interstitial fibrosis is the morphological criterion of reversibility of renal failure. Significant interstitial fibrosis in МM patients and severe renal failure develop within two-three months.