FEATURES OF THE COURSE OF COMORBID PATHOLOGY IN PATIENTS ON PROGRAM HEMODIALYSIS TAKING INTO ACCOUNT THE PRESENCE OF DIABETES MELLITUS

Rustamian S. T.

CLINICAL AND EXPERIMENTAL MEDICINE

Scentific article

Abstract. The world pays a lot of attention to the study of various risk factors that affect the survival and mortality of patients undergoing renal replacement therapy. In Ukraine, not enough attention is paid to the study of these factors. Despite the successful reduction in mortality and increased life expectancy in patients on program or outpatient, in peritoneal, dialysis, mortality from complications in dialysis patients is 6-8 times higher than in the general population. High mortality encourages both foreign and Ukrainian scientists to look for potential factors that most threateningly complicate the underlying disease of dialysis patients. The study of comorbid pathology in patients with end-stage chronic renal failure is of great importance. Understanding the features of comorbidity in dialysis patients will help improve diagnosis and rational drug treatment. The comorbidity index calculation system allows doctors to assess the level of comorbidity, determine prognostic indicators of 10-year survival and optimize treatment tactics. This work is devoted to the study of the peculiarities of the course of comorbid pathology in patients undergoing programmed hemodialysis, taking into account the presence of type 2 diabetes. The study involved 93 patients who were treated at the Center for Nephrology and Dialysis at the Poltava Regional Clinical Hospital M.V. Sklifosovsky. The experimental group – 44 patients who were on renal replacement therapy, namely on program hemodialysis, and 49 patients – a control group with chronic kidney disease stage I-II. In turn, 44 patients from the experimental group were divided into two subgroups: 20 patients diagnosed with diabetic nephropathy, the other 24 – non-metabolic diseases. Of the 49 patients in the control group – 26 patients with diabetic nephropathy, the other 23 patients without diabetic nephropathy, respectively. The Charlson system was used to calculate the comorbidity index of prognostic indicators of mortality risk during the year and 10 – year survival. The study found that no patient with end-stage renal disease had mononosological pathology, but other comorbid conditions were detected: secondary anemia, hypertension, cardiovascular disease (left ventricular hypertrophy, chronic heart failure, arrhythmia and/or conduction), secondary hyperparathyroidism, peripheral vascular disease, etc. In the structure, regardless of the presence or absence of diabetes, the most common complicated comorbid conditions are secondary anemia, which is observed in all study groups, hypertension 95% and 91.6% and secondary hyperparathyroidism, which ranks third and is 90% and 83.3% in the experimental group with diabetes mellitus and the experimental group without diabetes mellitus, respectively. The difference in the percentage of lesions of the cardiovascular system, peripheral vessels, retina and cerebrovascular lesions is noteworthy. In the experimental group with diabetes, the rates of damage to these systems are higher than in the experimental group without diabetes, which indicates a negative impact of diabetes on the affected organs and systems (except uremic intoxication due to chronic renal failure). The average comorbidity index with age tends to increase in both men and women. The highest averages are determined in the experimental group with diabetes in women and men older than 50 years (8.3±0.8 and 8.6±1.3, respectively). According to the results of calculating the comorbidity index to determine 10-year survival, it was found that in the experimental group with diabetes, regardless of age and sex, 100.0% of patients have a low 10-year survival rate – 21% and below. The results of the analysis of the experimental group without diabetes are slightly different in relation to the experimental group with diabetes. Thus, 1 (4.2%) patient has 77% 10-year survival, 3 (12.5%) patients have 53% 10-year survival. Comparing the control group with diabetes mellitus with the control group without diabetes mellitus, it was found that 21% and below 10-year survival have 9 (34.6%) patients in the control group with diabetes mellitus, while in the control group without diabetes only 2 patients (8.7%). 99% of 10-year survival have 8 (34.9%) patients from the control group without diabetes, while in the control group with diabetes patients with this percentage were not detected, which again indicates the negative impact of diabetes on the course of renal pathology.

comorbidity, diabetes mellitus, programmed hemodialysis, renal failure.

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«Bulletin of problems biology and medicine» Issue 1 (159), 2021 year, 120-124 pages, index UDK 616.379-008.64-06-08

10.29254/2077-4214-2021-1-159-120-124