[Phosphorus and calcium metabolism and the cardiovascular system status in patients with early-stage chronic renal disease].

AIM: To define the impact of phosphorus and calcium metabolic disturbances in patients with early-stage chronic renal disease (CRD) on the cardiovascular system. SUBJECTS AND METHODS: The levels of phosphate (P), calcium, parathyroid hormone (PTH), 25(OH) vitamin D and 1,25(OH)2 vitamin D, serum lipidogram, carotid artery intima-media thickness (IMT), and X-ray degree of abdominal artery calcification (AAC) were determined and echocardiography, electrocardiography and blood pressure monitoring were made in 465 patients with Stages I-V CRD who did not receive renal replacement therapy (of them, 73.5% of the patients had early (I to III) stages). RESULTS: Blood 1,25(OH)2D was related inversely to left ventricular (LV) posterior wall thickness, blood pressure (BP), triglycerides, and the degree of AAC and correlated directly to the severity of LV diastolic dysfunction and inversely to IMT, the presence of coronary heart disease and heart failure (HF). ACC, LV hypertrophy, and arterial hypertension (AH) were more significant in patients with higher serum levels PTH and P. CONCLUSION: In patients with early-stage CRD, phosphorus and calcium metabolic disturbances promote the development of AH, vascular and cardiac valvular calcification, myocardial hypertrophy, and HF.

[Correlations between the levels of vitamin D, parathormone, calcium, blood phosphates in patients with chronic kidney disease not treated with kidney replacement therapy].

AIM: To characterize correlations between the levels of vitamin D, parathormone, calcium, blood phosphates in patients with different stages of chronic disease of the kidney (CDK) given no therapy replacing renal function (TRRF). MATERIAL AND METHODS: Serum levels of creatinine, electrolytes, parathormone (PTH), 25(OH)-vitamin D (calcidiol-CD), 1,25 (OH)2-vitamin D (calcitriol-CT), calcium (Ca) and phosphates (P) excretion with urine were studied in 465 patients aged 52.2 +/- 15.5 years with CDK stage I-V given no TRRF having mean glomerular filtration rate (GFR) 51.8 +/- 27.1 ml/min. RESULTS: A CT level lowered with CDK progression and directly correlated with GFR, blood levels of Ca and CD. Correlation with PTH was not found. CD did not correlate with GFR. PTH rose from stage II CDK and its concentration in the blood correlated negatively with GFR, blood Ca (in lesser degree), directly correlated with P. Ca lowered at stage V of CDK, P--at stage II, increased at stage IV. In reduction of GFR 24-h excretions of P and Ca diminished in spite of growth of their excreted fractions and were related directly with CT. CONCLUSION: A rise of PTH and fall of CT occur at early CDK stages. P disbolism seems to play a key role in genesis of hyperparathyrosis. We are the first to show lowering of 24-hour Ca and P excretion with CDK progression which may be caused by a progressive CT deficiency.

[Heart valve calcification in patients with chronic kidney disease].

The aim of the study was to identify factors related to heart valve calcification (HVC) and effect of HVC on intracardiac hemodynamics in patients with chronic kidney disease (CKD). 377 CKD patients of the control group and 132 ones treated by hemodialysis (HD) were examined using echocardiography, cardiomonitoring, measurement of the carotid intima-media thickness and mineral bone density, X-ray imaging of calcified abdominal aorta. HVC was diagnosed in 38.9 and 27.3% of the CKD patients on hemodialysis and without it respectively. In both groups, patients with HVC were older than HVC-free ones, more of them had coronary heart disease, cardiac insufficiency, aortic calcinosis, and biochemically identifiable inflammation. In the absence of hemodialysis, patients with HVC had thicker intima-media compex, lower glomerular filtration rate, higher arterial pressure, and increased occurrence of diabetes mellitus. In HVC patients receiving hemodialysis, its duration was longer, blood PTH and calcium levels higher, forearm MOC lower. HVC associated with stenosis of mitral and aortic valves, aortic regurgitation, enlarged left and right atrium, thickened left and right ventricular wall. Multifactor analysis showed that HVC in patients receiving hemodialysis was related to the age, disbalance of phosporus and sodium, and duration of hemodialysis; in its absence, it was related to intima-media thickness and diabetes mellitus. Thus, in patients of the latter group, HVC was in the first place associated with atherosclerosis aggravated by a decrease of glomerular filtration rate and with the presence of diabetes. In patients receiving hemodialysis, HVC correlated with phosporus/sodium disbalance and atherosclerosis. The study revealed negative effect of HVC on intracardiac hemodynamics and for the first time demonstrated decreased MOC in patients with HYC.

[Aortic valve prosthesis and the plication of a dissecting aneurysm of the ascending aorta in a patient with infectious endocarditis against a background of chronic kidney failure and its management by regular hemodialysis]. / Protezirovanie aortal'nogo klapana i plikatsiia rasslaivaiushchei anevrizmy voskhodiashchei aorty u bol'nogo infektsionnym éndokarditom na fone khronicheskoi pochechnoi nedostatochnosti i provedeniia reguliarnogo gemodializa.

Some literature data are presented on the problem of cardiac surgery in patients with chronic renal insufficiency under regular hemodialysis and on the specificity of performing operations on such patients under conditions of artificial circulation. The authors describe their first experience of a one-step prosthezing of the aortal valve and plication of the dissecting aneurysm of the ascending part of the aorta in the patient receiving the regular hemodialysis during 5 years as well as the positive results of this original operation in dynamics of the first year of observations.