Chronic Kidney Disease as Basis of High Thrombotic and Bleeding Risk in Patients With Atrial Fibrillation: Place of Oral Anticoagulants.

Chronic kidney disease (CKD) aggravates course of practically all diseases by worsening outcomes and hindering adequate treatment. Specificities of renal excretion of various drugs, changes of parameters of their pharmacokinetics and pharmacodynamics, nephrotoxic effects of drugs, tactics of drug therapy in conditions of CKD, terminal stage of kidney failure and dialysis are in the focus of attention of internists. To a greatest degree difficulties of drug therapy in CKD and associated clinical states refer to the group of anticoagulants. Kidney diseases and related complications of anticoagulant therapy served as stimulus for search for new pharmacological approaches in anticoagulation, which resulted in creation and elaboration of novel oral anticoagulants (NOACs). NOACs are characterized by rapid onset and cessation of action, predictable pharmacokinetics, low potential of interaction with drugs and foods. Indicators of efficacy and safety of NOACs are similar to those of warfarin. Nevertheless, hemorrhagic and thrombotic events constitute the basis of further theoretical and practical investigations. These complications also stimulate aiming at selection of safest and balanced medicines. In this article we present various aspects of use of direct oral anticoagulants mostly in patients with CKD associated with atrial fibrillation.

[Hemodynamic effects of succinate-containing dialyzing solution].

AIM: To assess the results of using an acetate-free succinate-containing dialyzing solution (SDS) against natremia and blood pressure (BP) in patients on chronic hemodialysis (HD). SUBJECTS AND METHODS: Ninety-two patients were transferred from 3 Saint Petersburg HD centers to 3-month HD treatment using SDS. The investigators measured blood biochemical indicators immediately before and 1 and 3 months after the investigation, BP before and after a successive HD session, and the patients' weight and its gain in the period between HD sessions. Hypotensive and hypertensive episodes were recorded during HD sessions throughout the investigation. RESULTS: Following 3-month treatment using SDS, there were statistically significant decreases in blood sodium levels and systolic BP (SBP) prior to a HD session. At the same time, patients with a baseline pre-HD SBP of less than 100 mm Hg were observed to have a statistically significant increase in this indicator by the end of the investigation. Pre-dialysis diastolic BP (DBP) and post- dialysis SBP and DBP substantially unchanged. After 3 months of SDS use, there was a statistically significant reduction in weight gain in the period between HD sessions. When SDS was administered, the frequency of hypertensive episodes tended to decline after a HD session. CONCLUSION: The use of SDS causes a drop in pre-dialysis blood sodium levels, ensuring adequate dehydration in patients and improving hypertension control. In doing so, SDS prevents hypotension during a HD session.

[Use of the Charlson comorbidity index and the Barthel disability index in the integrated assessment of the sociomedical status of patients receiving continuous renal replacement therapy with hemodialysis].

AIM: To make an integrated assessment of the sociomedical status of patients receiving continuous renal replacement therapy (RRT) with hemodialysis (HD), by using the Charlson comorbidity index (CCI) and the Barthel disability index (BI) and to analyze the compliance of these indices with the disability severity estimated according to disability group (DG). SUBJECTS AND METHODS: The medical records of 605 HD patients (323 men, 282 women) whose mean age was 56.4 ± 13.9 years and mean RRT duration was 65.6 ± 62.8 months, were analyzed. The patients were grouped according to DG, CCI, BI, employment, and a history of diabetes mellitus. Data on basic laboratory parameters were collected. RESULTS: According to DG, the patients were grouped as follows: 1) 292 (51%); 2) 212 (37%); 3) 15 (3%) and 4) 48 (9%) without DG. The disability severity estimated according to DG was found to be correlated with RRT duration (r = -0.35; p < 0.001) and employment (r = 0.36; p < 0.001). CCI averaged 6.3 ± 3.1 scores (n = 486). The mean BI was 86 ± 14 scores (n = 224). Among the respondents completing the BI questionnaire, 26 (20%) patients with DG 1 showed an uncomplicated comorbid background (CCI, 2-5 scores), no significant disability (BI, 90-100 scores), while 33 (48%) patients with DG 2 exhibited a high comorbidity index (ICC, more than 5 scores) and obvious disability (BI, less than 90 scores). The indicators relating to restricted self-movement in some BI scales were of the most importance. CONCLUSION: The disability severity estimated in view of DG does not correspond to the severity of comorbidities (CCI) and the magnitude of functional limitations (BI) in some patients with CKD 5D. While determining DG, it is advisable to take into account CCI as an indicator of the severity of physical disorders to objectify the estimate of the sociomedical status of patients with CKD 5D, as well as BI to determine the degree of disability.