[The role of the phenomenon of the redistribution of aminoglycosides in their monitoring and dosage calculation in patients in the terminal stage of kidney failure undergoing systematic hemodialysis treatment]. / Rol' fenomena pereraspredeleniia aminoglikozidov v ikh monitoringe i raschete doz u bol'nykh s terminal'noi stadiei pochechnoi nedostatochnosti, nakhodiashchikhsia na lechenii sistematicheskim gemodializom.

The kinetics of aminoglycosides (amikacin, netilmycin, gentamicin, tobramycin) were investigated in patients with end-stage renal disease who were on systemic hemodialysis. Their decrease in the blood revealed in pre-dialysis and dialysis periods was exponential. After dialysis termination there was a gradual aminoglycoside increase as compared to the end-dialysis period, which was of linear character and depended on the degree of these agents' dialysis clearance. The cause of the phenomenon is likely to be higher aminoglycoside blood elimination rate than their entering the blood from tissues. A method is proposed to calculate an additional dose of aminoglycosides, taking into account their higher concentrations in the postdialysis period, under permanent monitoring of their blood levels.

[Changes in the beta 2-microglobulin level during hemodialysis]. / Izmenenie urovnia beta 2-mikroglobulina vo vremia gemodializa.

The authors studied changes of the beta 2-microglobulin level during hemodialysis with dialyzers AIP-02-02 (cuprophane membrane), E2 (cuprophane membrane), AIP-03-02 (polysulfone membrane), F60 (polysulfone membrane), and hemodiafiltration with dialyzer F60. The following data were obtained. The beta 2-microglobulin level in patients undergoing hemodialysis is approximately 20 times the normal level. No essential fluctuations of the level of this protein occurs during hemodialysis and hemodiafiltration. The cuprophane membrane does not cause increase of beta 2-microglobulin generation during hemodialysis. Standard hemodialysis with the cuprophane membrane and the highly-permeable polysulfone membrane does not lead to decrease of the beta 2-microglobulin level. Hemodiafiltration with the highly-permeable polysulfone membrane is an effective method for the elimination of this protein.

[The effect of heparin on the lipid level during hemodialysis]. / Vliianie geparina na uroven' lipidov vo vremia gemodializa.

The level of free fatty acids, triglycerides, and total lipids was studied in dynamics during hemodialysis. At the beginning of hemodialysis, fatty acids are discharged into the blood flow and their level at 20 min of hemodialysis is three-fold the initial level. Plasma triglycerides, which are components of lipoproteins, are the source of the discharge of free fatty acids. This is confirmed by the fact that the triglyceride content reduces simultaneously with the increase in the level of free fatty acids. The concentration of total lipids practically does not change during hemodialysis. The possible significance of a sharp increase of the free fatty acid level during hemodialysis is discussed.

[Plasmapheresis in the combined therapy of the acute rejection reaction and of suppurative-septic complications in the pretransplantation period]. / Plazmaferezv kompleksnoi terapii ostroi reaktsii ottorzheniia i gnoino-sepicheskikh oslozhnenii predtransplantatsionnogo perioda.

To define the efficacy of plasmapheresis performed as part of combined treatment for steroid-resistant patterns of acute rejection of a renal transplant, the results of the treatment were analysed in 11 patients. The analysis also involved the results of plasmapheresis treatment of 3 patients with terminal renal failure complicated with septic conditions and 1 patient with stenosed artery of the transplanted kidney and irreversible arterial hypertension. Plasmapheresis was used in various terms of rejection after a 3-4-day prednisolone pulsatile therapy. The effect of the procedure was recorded in 7 out of 13 patients, i. e. in 50 per cent of those treated. The necessity of applying early plasmapheresis (immediately after methylprednisolone pulsatile therapy in case of its failure) was demonstrated as were the methods of intensive plasmapheresis performance (daily within 4-5 days). The technique permitted to eliminate septic conditions before and after the period of transplantation, to decrease blood pressure in the patients with stenosed arteries of transplanted kidney. The authors considered the mechanism of the curative effect of plasmapheresis in the patients with acute rejection and the criteria for its efficiency.

[The effect of hemodialysis on lipid peroxidation]. / Vliianie gemodializa na perekisnoe okislenie lipidov.

With regard to the variance in the levels of lipid peroxidation products (malonic dialdehyde and diene conjugates) the authors studied the impact of hemodialysis on lipid peroxidation. Transitory activation of lipid peroxidation with a subsequent decrease in the levels of lipid peroxidation products that were lower than initial ones were noted at the initial stages of hemodialysis performed with the use of a DEP-02-02 dialyzer (with a cuprophane membrane). The comparison of the input and output levels of lipid peroxidation products failed to demonstrate any generation of lipid peroxidation products inside the dialyzer. The systemic character of the activation effect in the onset of dialysis was established. It was proved that the effect did not depend on the material used for the membrane as there was no rise in the levels of lipid peroxidation products but a decrease in their concentration when the capillary dialyzers D1 and B2-100 were used. The study of the washings from the cuprophane membrane from the dialyzer DEP-02-02 demonstrated high levels of endotoxin which were several times higher than in those from the same membrane from the dialyzer D2. Endotoxin release into the circulation probably determined the transitory effect of the activation in the onset of the procedure performed with the dialyzer DEP-02-02. The authors discussed the possible origin of high initial levels of lipid peroxidation products observed in patients with terminal chronic renal failure who had undergone hemodialysis.

[The development of calcium metabolic disorders in patients in the terminal stage of chronic kidney failure receiving hemodialysis treatment]. / Razvitie narushenii obmena kal'tsiia u bol'nykh s terminal'noi stadiei khronicheskoi pochechnoi nedostatochnosti, poluchaiushchikh lechenie gemodializom.

To follow calcium metabolism in patients with a terminal stage of chronic renal failure who are on hemodialysis treatment is necessary for the assessment of phosphorus/calcium metabolism in a whole, efficiency of conservative treatment, indications to surgical intervention (parathyroidectomy, renal allotransplantation). The investigation included the assessment of total and ionized calcium blood plasma levels with regard to hemodialysis duration; the correlation of clinical and roentgenological picture of secondary hyperparathyroidism. A total of 222 patients were observed, and with regard to hemodialysis duration allocated into 5 groups: in the first hemodialysis lasted for not more than 3 mos; in the second--from 3 mos to 1 yr; third group with its duration from 1 to 2 yrs; fourth, when it lasted from 2 to 3 yrs; and the fifth group--hemodialysis lasted for more than 3 yrs. It was documented that disorders in calcium metabolism were increasing in parallel with the duration of hemodialysis. Clinical and roentgenological picture of hyperparathyroidism was accompanied by an evident increment of blood plasma ionized calcium while the levels of total blood calcium were but slightly changed. As a part of combined diagnosis ionized calcium assessment is helpful in early prevention and management of calcium metabolism disorders.

[Reprocessing of capillary dialyzers]. / Reprotsessing kapilliarnykh dializatorov.

Changes in biocompatibility parameters of the cuprophan membrane, used repeatedly after reprocessing, were assessed. It is demonstrated that when the dialyzer is applied for the second of third time, cuprophan membrane loses its ability to induce acute dialysis leucopenia, typical for first application. Repeatedly used dialyzers also failed to cause bone-marrow irritation, which at first use induced a release of juvenile neutrophils into the circulation. Prior to first application, 6 dialyzers were subjected to 3 reprocessing procedures each. In all three, the cellulose membrane did not lose its ability to cause acute leucopenia. Therefore, the chemical reagents used in reprocessing (hydrogen peroxide, sodium hypochlorite and formaldehyde) are not the cause of membrane's loss of ability to induce leucopenia. Used for 3 times running, capillary dialyzers do not essentially lose their effective capillary volume. To determine whether the dialyzer is suitable for repeated use, both visual and objective check-up of the device is necessary. Some aspects of reprocessing technology are discussed.

[Activation of monocytes during hemodialysis]. / Aktivatsiia monotsitov vo vremia gemodializa.

The authors conducted a clinical study of the hypothesis of interleukin-1 regarded as one of the most important topics in the problem of biocompatibility of dialytic membranes. Hemodialyses (HD) were performed using different cellulose and synthetic membranes. During HD research was made into the kinetics of monocytes and lymphocytes, monocytic activation expressed by a stimulation index, and the deposition of blood elements on the membranes of parallel membrane dialysers. All types of cellulose membranes were characterized by acute dialytic monocytopenia. Synthetic membranes produced no considerable monocytopenia. No convincing data on the dependence of the monocytic stimulation effect on membrane material were obtained. Possible mechanisms of monocytic activation during HD were discussed.