[Determination of brain natriuretic peptide levels and its N-terminal fragment for the evaluation of renal replacement therapies efficiency in patients with decompensated chronic heart failure].

AIM: to compare the capabilities of identifying different types of brain natriuretic peptide (BNP) for the evaluation of renal replacement therapy modalities in patients with decompensated chronic heart failure (CHF). SUBJECTS AND METHODS: Patients (31 men and 9 women) aged 30 to 82 years with functional class II-IV CHF in its decompensation phase were examined. The patients were divided into 2 groups. A study group received medical therapy for CHF, such as angiotensin-converting enzyme inhibitors or angiotensin II receptor antagonists, verospirone, beta-adrenoblockers, digoxin, loop diuretics (furosemide, diuver, in the doses not exceeding those taken before admission) in combination with renal replacement therapy: slow continuous ultrafiltration (SCUF) or continuous venovenous hemofiltration (CVVHF). A control group had only medical therapy for CHF (intravenous furosemide in the doses doubling those used before admission, i.e., > or =80 mg/day required for an adequate response to the drug--daily urine volume >1 liter). The patients from the study and control groups received furosemide < or =40 mg/day or torsemide < or =20 mg/day after a course of SCUF or CVVHF sessions or intravenous furosemide. There were 4 examination stages [control study points (CSP)]: (1) before study; (2) after CHF compensation achievement (a day before hospital discharge); (3) following 90 days; (4) following 180 days. The plasma concentration of active BNP was measured by enzyme immunoassay; that of the N-terminal fragment of BNP (NT-proBNP) was estimated on an analyzer. RESULTS: There were direct correlations between the content of BNP and that of NT-proBNP) in all CSPs in the patients from both groups. The study group showed a significantly greater weight loss, which was accompanied by a more pronounced reduction in systolic pulmonary artery pressure, pulmonary venous hypertension, hydrothorax elimination, decreased liver size, lower plasma aldosterone concentration, decreased heart size, and higher left ventricular ejection fraction (LVEF). The study group displayed a steady-state reduction in the plasma concentrations of both BNP and NT-proBNP, significant inverse correlations between the lower BNP level and the higher LVEF throughout the follow-up. CONCLUSION: Extracorporeal dehydration techniques are more effective that intravenous diuretics. The direct correlations between the content of BNP and that of NT-proBNP and between the change in their concentrations during treatment assume the capacity and objectification of diagnosing CHF and its degree, by determining only one of the types of BNP.

[Application of methods of renal replacement therapy for abolishment of hyperhydration in patients with decompensated chronic heart failure].

UNLABELLED: Slow continuous ultrafiltration (SCUF), continuous veno venous haemofiltration (CVVHF) are alternative to diuretics methods of treatment of patients with chronic heart failure (CHF), edematous syndrome. METHODS: Patients of both sexes aged 30-82 years with functional class II-IV CHF were included because of decompensation of CHF. Randomization: experiment - 19 patients, 3-4 component therapy plus SCUF or CVVHF; control - 3-4 component therapy plus intravenous furosemide. EXAMINATION: I ñ at baseline, II ñ after compensation of CHF. RESULTS: Delta weight (kg) - experiment -10.1+/-1.08, control -1.92+/-0.83, p=0.00001; Delta left ventricular ejection fraction - experiment +10.09+/-2.26, control +0.52+/-1.14, p=0.0007; pulmonary artery systolic pressure (mm Hg) - experiment -12.32+/-3,43, control -4.05 +/-2.07, p=0.029; Delta 6 min walk test: experiment +304.22+/-39.4, control +91.91+/-23.4, p=0.00003; Delta glomerular filtration rate - experiment -1.16+/-3.23, control +4.44+/-3.68, p=0.85; duration of hospitalization (days) - experiment 17.26+/-1.43, control 17.52+/-1.02, p=0.59. We did not observe complications related to renal replacement therapy. CONCLUSION: SCUF and CVVHF are safe for patients. In decompensated CHF SCUF and CVVHF provide greater weight reduction and fluid removal than intravenous diuretics, abolish hypervolemia what cause improvement of myocardial contractility.

[Increased QRS voltage during dehydrating].

AIM: To assess QRS voltage changes with lower total amount of biological fluids under ultrafiltration during hemodialysis. MATERIALS AND METHODS: The study included 14 patients with chronic renal failure. An average of 2.5 +/- 0.24 liters of fluid were removed during a session. 12-lead standard ECG was continuously recorded by means of a computer-aided cardiac recorder throughout the session of hemodialysis. Changes in the amplitude of QRS waves were analyzed in each lead. RESULTS: Elevated QRS voltage was most pronounced in the anterior chest leads (v1-v4). Moreover, the potentials corresponding to the propagation of a predominant excitation front over the cardiac surface facing both the anterior chest wall--QRS+ (R wave) and the posterior chest wall--ORS-(S or Q waves) increased in most cases. Voltage changes in these leads were observed in 90% of patients, the amplitude of the waves being increased by more than 0.5 mV. CONCLUSION: During dehydration, lower chest tissue electroconductivity may cause a considerable increase in QRS voltage. This should be kept in mind while analyzing ECG data during both a session of hemodialysis and antihypertensive therapy resulting in some fluid loss, as well as in the treatment of cardiac and renal failure, leading to diminished concomitant edemas.

[The ECG changes during the performance of hemodialysis using dialysis solution concentrates with different potassium levels in patients with chronic kidney failure and normokalemia]. / Izmeneniia na EKG pri provedenii gemodializa s ispol'zovaniem kontsentrata dializiruiushchego rastvora s razlichnym soderzhaniem kaliia u bol'nykh s khronicheskoi pochechnoi nedostatochnost'iu i normokaliemiei.i

Seven patients with chronic renal failure and normokalemia underwent 56 hemodialysis procedures (4 procedures each) using a dialysis solution concentrate containing 2.0 mmol/l (4 procedures) and 3.0 mmol/l potassium (4 procedures). Other electrolytes in the concentrates were the same. It was found that administration of 2.0 mmol/l K concentrate in 4 patients led to ECG changes indicative of hypokalemia. The changes can be managed by slowing down the speed of K elimination from the blood. This is achieved with the solution concentrate containing K 3.0 mmol/l.

[The use of plasmapheresis in the combined treatment of patients with unstable stenocardia]. / Primenenie plazmafereza v kompleksnom lechenii bol'nykh nestabil'noi stenokardiei.

Plasmapheresis (PA) was provided to 82 patients with unstable angina pectoris refractory to drug treatment. PA did not influence blood osmolarity, acid-base equilibrium or blood electrolyte level. The patients manifested a slight rise of hematocrit and a decrease of plasma oncotic pressure. PA gave rise to a significant lowering of blood viscosity, a reduction of blood fibrinogen, total protein, cholesterol and triglycerides. Clinically, there was a marked decline of the frequency of angina pectoris of rest and effort attacks. The doses of antianginal drugs could be reduced. PA brought about a significant rise of the count of rosette-forming cells. The increase of drug sensitivity induced by PA sessions correlated with the clinical efficacy of the treatment. Later on the antianginal effect was attained with far lower drug doses.

[Effect of isolated ultrafiltration on plasma hormone levels in patients with heart failure resistant to drug therapy]. / Vliianie izolirovannoi u'ltrafi'ltratsii na soderzhanie gormonov v plazme krovi bo'lnykh s refrakternoi k terapii serdechnoi nedostatochnos'tiu.

The positive action exerted by isolated ultrafiltration on 69 patients with refractory heart failure was shown to be due to the complex interaction of effects produced by ultrafiltrate removal. Among the effects, a leading role is played by therapy for hyperaldosteronism and reduction of antidiuretic hormone levels along with improvement of the functional status of the liver and heart.

[Hemosorption in the treatment of patients with ischemic heart disease and drug-resistant stenocardia]. / Gemosorbtsiia v lechenii bo'lnykh ishemicheskoi bolez'niu serdtsa s refrakternoi k medikamentoznoi terapii stenokardiei.

A course of hemosorption combined with chemotherapy resulted in much less frequent attacks of angina pectoris and in compensation of cardiac insufficiency in 27 coronary heart disease patients resistant to chemotherapy. There was an increase in the drugs efficacy. Sensitivity of the lymphocytes to chemotherapeutic agents administered rose as shown by rosette test due to specific unlocking of the receptors. The underlying mechanism of hemosorption-related compensation of cardiac insufficiency implies correction of secondary hyperaldosteronism and a decrease in the level of ADH leading to enhanced diuresis, natriuresis, inhibited kaliuresis and to normal values of blood electrolytes.

[Effectiveness of low-volume hemofiltration in treating severe arterial hypertension with initial manifestations of renal failure]. / Effektivnost' nizkoob''emnoi gemofil'tratsii v lechenii tiazheloi arterial'noi gipertonii s nachal'nymi proiavleniiami pochechnoi nedostatochnosti.

High efficiency of low-volume hemofiltration, replacing 7 to 8 litres of the filtrate, is demonstrated. It has been used as part of combined treatment in 10 patients with severe arterial hypertension in combination with early signs of chronic renal failure. Low-volume hemofiltration brings down arterial blood pressure and allows reduced doses of hypotensive drugs; moreover, it improves basically eye-ground appearance in cases of malignant arterial hypertension as well as renal nitrogen excretion. Possible mechanisms of the hypotensive effect of low-volume hemofiltration, in addition to volume reduction, may be the control of secondary hyperaldosteronism and increased diuresis and natriuresis.

[Isolated ultrafiltration of the blood in patients with refractory heart failure: the status of the renin-angiotensin-aldosterone system and the secretion of antidiuretic hormone]. / Izolirovannaia ul'trafil'tratsiia krovi u bol'nykh refrakternoi serdechnoi nedostatochnost'iu: sostoianie renin-angiotenzin-al'dosteronovoi sistemy i sekretsiia antidiureticheskogo gormona.

Isolated ultrafiltration was performed in 107 patients with refractory heart failure (HF) which developed in the presence of different cardiovascular diseases. The beneficial action of isolated ultrafiltration in 71 patients (68%) with refractory HF was determined by complex interaction of the effects provoked by ultrafiltrate removal. Among those effects of paramount importance was correction of secondary hyperaldosteronism and reduction of the concentration of antidiuretic hormone accompanied by the improvement of liver and heart functions.

[Isolated ultrafiltration in refractory cardiac insufficiency]. / Izolirovannaia ul'trafil'tratsiia pri refrakternoi serdechnoi nedostatochnosti.

The efficiency of isolated ultrafiltration was demonstrated in 101 patients with refractory heart failure developing in the presence of myocardial abnormalities. Catheterization of major (femoral or subclavian) veins is shown to be the optimum vascular access for isolated ultrafiltration; patient's blood can be returned through the needle catheter placed into the cubital vein. To prevent possible complications of isolated ultrafiltration, packed cell volume, central venous pressure and end diastolic pressure in the pulmonary artery should be monitored.

[Combined use of hemosorption and isolated ultrafiltration of the blood in patients with refractory heart failure]. / Sochetannoe primenenie gemosorbtsii i izolirovannoi ul'trafil'tratsii krovi u bol'nykh s refrakternoi serdechnoi nedostatochnost'iu.

Combination of isolated blood ultrafiltration (IBUF) and hemosorption (HS) produced subcompensation of severe congestive heart failure (CHF) in 10 of 14 patients refractory of IBUF alone and to drug therapy. HS included in the therapy complex was the only way to correct secondary hyperaldosteronism, to reduce antidiuretic hormone blood level, to increase diuresis and natriuresis and to reduce kaliuresis as well as to normalize blood electrolyte level. The withdrawal of excessive water with IBUF and bilirubin and creatinine with HS as well as direct detoxication effect on the liver with HS reduced in most patients hyperbilirubinemia, hypoproteinemia and azotemia--aggravating factors in patients with CHF.

[Use of bicarbonate dialysis in patients with terminal renal failure]. / Primenenie bikarbonatnogo dializa u bol'nykh s terminal'noi pochechnoi nedostatochnost'iu.

Six patients with terminal renal failure were subjected to a comparative assessment of the effects of acetate and bicarbonate dialyses on acid-base and gas composition of the blood as well as on the tolerance to the procedures conducted. It is shown that the cross-over of the patients to bicarbonate dialysis made it possible to appreciably reduce the number of side effects. The rate of hypotonia and muscular convulsions reduced by 50%, headache by 30%, nausea and vomiting practically disappeared. The use of the bicarbonate-containing dialysing solution prevented hypoxemia while acidosis correction was more adequate.

[The efficacy of isolated ultrafiltration of the blood in patients with refractory heart failure]. / Ob éffektivnosti izolirovannoi ul'trafil'tratsii krovi u bol'nykh s refrakternoi serdechnoi nedostatochnost'iu.

Application of isolated ultrafiltration (IUF) of blood in 70 out of 100 patients with refractory heart failure (HF) made it possible, acting on some mechanisms of water excretion disorders, to attain the compensation for the HF signs. At the same time the correction of the manifestations of secondary hyperaldosteronism, hypoproteinemia, hyperbilirubinemia, and azotemia was attained only thanks to the presence of the functional reserves of the liver and kidneys. In 35 patients with cachectic HF, IUF failure was determined by marked cardial liver cirrhosis together with depletion of the functional reserves of the cardiovascular system. The lack of sufficient diuresis, hyponatremia, hypoproteinemia, and hyperbilirubinemia may be unfavourable prognostic signs despite the reduction of HF intensity consequent on IUF.

[Use of plasmapheresis in the treatment of patients with severe arterial hypertension refractory to drug therapy]. / Primenenie plazmafereza dlia lecheniia bol'nykh s vysokoi arterial'noi gipertoniei, refrakternoi k medikamentoznoi terapii.

Thirty patients with severe and malignant arterial hypertension (AH) received 1-4 sessions (in most cases 2) of plasmapheresis to overcome refractiveness to drug therapy. Stable BP reduction, improvement of the vascular picture of the fundus of the eye and raised sensitivity to antihypertensive therapy were noted in 26 patients. Though antihypertensive drug dosages were reduced, the antihypertensive effect of plasmapheresis could be observed within 3-8 mos (an average of 5.3 +/- 0.5 mos). The efficacy of plasmapheresis was approximately equal both in symptomatic AH and in essential hypertension. Plasmapheresis was shown to be a method of overcoming refractiveness to antihypertensive therapy which could not be used alone for therapy of refractory AH. Possible mechanisms of BP reduction after plasmapheresis were discussed.

[Treatment of refractory arterial hypertension by plasmapheresis]. / Lechenie refrakternoi k terapii arterial'noi gipertonii s pomoshch'iu plazmafereza.

58 patients with severe arterial hypertension (AH) refractory to antihypertensive drug therapy including beta-blockers, calcium antagonists, antiadrenergic drugs and diuretics with addition of captopril and/or minoxidil were studied. In all the patients 3-6 sessions of plasmapheresis (PA) with plasma exchange up to 30 ml/kg body weight per 1 session were performed. After the course of plasmapheresis BP depression on the average by 24% as well as restoration of sensitivity to antihypertensive drugs and elimination of signs of malignant AH in certain cases were observed. PA was not enough effective in patients with AH combined with signs of chronic renal failure. Persistent BP depression as a result of the treatment is probably caused by positive hormonal changes, improved renal function, increased sensitivity of tissue receptors of target organs to antihypertensive drugs as well as improved peripheral blood circulation.