nefrНефрологияNephrology (Saint-Petersburg)1561-62742541-9439Pavlov First Saint-Petersburg State Medical University10.36485/1561-6274-2022-26-4-50-65nefr-2160Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИ. КЛИНИЧЕСКИЕ ИССЛЕДОВАНИЯORIGINAL ARTICLES. CLINICAL INVESTIGATIONSТемпы прогрессирования хронической болезни почек на поздних стадиях и динамика параметров уремического синдромаThe rate of chronic kidney disease progression in advanced stages and the dynamics of the uremic syndrome parametershttps://orcid.org/0000-0002-1903-2630СадовскаяД. С.SadovskayaD. S.

Садовская Дарья Сергеевна

кафедра внутренних болезней, клинической фармакологии и нефрологии

191015

ул. Кирочная, д. 41

Санкт-Петербург

тел.: 8(812)543-05-86

Daria Sergeevna Sadovskaya

Department of Internal Diseases, Clinical Pharmacology and Nephrology

191015

Kirochnaya str., 41

St. Petersburg

tel.: 8(812)543-05-86

dssadovskaya@gmail.comhttps://orcid.org/0000-0001-6945-4711ВишневскийК. А.VishnevskyK. A.

Вишневский Константин Александрович, канд. мед. наук

кафедра внутренних болезней, клинической фармакологии и нефрологии

191015

ул. Кирочная, д. 41

Санкт-Петербург

тел.: 8(812)543-05-86;

191014

Литейный пр., д. 56

Санкт-Петербург

тел.: (812) 605-03-03

Vishnevsky Konstantin Alexandrovich, MD, PhD

Department of Internal Diseases, Clinical Pharmacology and Nephrology

191015

41 Kirochnaya str.

St. Petersburg

tel.: 8(812)543-05-86;

191014

 Liteyny Ave., 56

St. Petersburg

tel. (812) 605-03-03

vishnevskii2022@mail.ruhttps://orcid.org/0000-0003-4564-5809КонаковаИ. Н.KonakovaI. N.

Конакова Ирина Николаевна

191014

Литейный пр., д. 56

Санкт-Петербург

тел.: (812) 605-03-03

Konakova Irina Nikolaevna

191014

56 Liteyny Ave

Saint Petersburg

tel. (812) 605-03-03

inkonakova@yandex.ruhttps://orcid.org/0000-0003-4075-4096БакулинаН. В.BakulinaN. V.

Бакулина Наталья Валерьевна, проф. д-р мед. наук

кафедра внутренних болезней, клинической фармакологии и нефрологии

191015

ул. Кирочная, д. 41

Санкт-Петербург

тел.: (812) 303-50-00

Natalia Valeryevna Bakulina, Prof., DMedSci

Department of Internal Diseases, Clinical Pharmacology and Nephrology

191015

Kirochnaya str., 41

St. Petersburg

tel.: (812) 303-50-00

nv_bakulina@mail.ruСеверо-Западный государственный медицинский университет им. И.И. МечниковаРоссияI.I. Mechnikov Northwestern State Medical UniversityRussian FederationСеверо-Западный государственный медицинский университет им. И.И. Мечникова; Городская Мариинская больницаРоссияI.I. Mechnikov Northwestern State Medical University; City Mariinsky HospitalRussian FederationГородская Мариинская больницаРоссияCity Mariinsky HospitalRussian Federation2022241120222645065Copyright © Садовская Д.С., Вишневский К.А., Конакова И.Н., Бакулина Н.В., 20222022Садовская Д.С., Вишневский К.А., Конакова И.Н., Бакулина Н.В.Sadovskaya D.S., Vishnevsky K.A., Konakova I.N., Bakulina N.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.nephrolog.ru/jour/article/view/2160

ВВЕДЕНИЕ. Сложившаяся практика ведения пациентов с поздними стадиями ХБП не является оптимальной, поскольку приводит к риску экстренного старта диализа с неблагоприятным прогнозом, не использует все возможности нефропротективной терапии и не обеспечивает оптимальную коррекцию важнейших уремических синдромов перед началом диализа, что ухудшает перспективу долгосрочного пациент-ориентированного лечения диализом. ЦЕЛЬ: полученная характеристика стандартной практики позволит в проспективном исследовании в тщательно сопоставленных группах оценить значимость компонентов предлагаемой программы интенсивного ведения пациентов с продвинутыми стадиями хронической болезни почек в «центре переходного периода». ПАЦИЕНТЫ И МЕТОДЫ. Группа регулярного (не менее 6 визитов в год) наблюдения в 540 человек с исходной ХБП3Б ретроспективно сформирована из базы данных Городского нефрологического центра, включавшей на начало исследования 7696 пациентов с ХБП3 и выше, и прослежена до потребности в заместительной почечной терапии или смерти. В рамках наблюдения пациенты проходили регулярное клинико-лабораторное исследование и получали нефропротективную терапию, которые фиксировались в базе данных. РЕЗУЛЬТАТЫ. Описана динамика ускоряющегося снижения рСКФ (по CKD-EPICr) от –2,76 (–3,26÷–2,36) к –4,34 (–5,01÷–3,46) и –6,01 (–7,11÷–5,23) мл/мин/1,73м2/год для стадий ХБП3Б→ХБП4→ХБП5 параллельно с динамикой уровней в крови гемоглобина (и железа), фосфатов (и кальция), альбумина, а также протеинурии – факторов, оказавшихся значимыми в модели множественной регрессии с зависимой переменной – темп снижения рСКФ (значимость модели F=2,864; p=0,015). ЗАКЛЮЧЕНИЕ. Полученное детальное описание прогрессирования ХБП в типичной региональной популяции в условиях стандартного ведения позволит сформировать группу из когорты регулярного наблюдения в нефроцентре, тщательно сопоставленную с группой интенсивного ведения в прообразе центра переходного периода на базе крупного стационарного диализного центра для оценки значимости компонентов предлагаемой программы контроля и вмешательств.

Background. The current practice of patients with advanced CKD stages management is not optimal, as it leads to the risk of an emergency dialysis start with an unfavorable prognosis, does not utilize all the possibilities of nephroprotective therapy and does not provide optimal correction of the most important uremic syndromes before starting dialysis, which worsens the per spectives of long-term patient-oriented dialysis treatment. THE AIM. The obtained features of the standard practice will provide the possibility to assemble group carefully matched with intensive management group to compare outcomes in future prospective study and to assess the significance of the proposed program components of the intensive management of patients with advanced stages of chronic kidney disease in the "transition center". PATIENTS AND METHODS. A group with regular (at least 6 visits per year) follow-up of 540 patients with baseline CKD3B was retrospectively formed from the city nephrology center database (which included 7696 patients with CKD3 and higher) and was traced to the need for renal replacement therapy or to death. As part of the follow-up, patients underwent regular clinical and laboratory evaluation and received nephroprotective therapy, which were recorded in the database. RESULTS. The dynamics of an accelerating decrease in eGFR (according to CKD-EPICr) from median of -2.76 (-3.26÷-2.36) to -4.34 (-5.01÷-3.46) and further to -6.01 (-7.11÷-5.23) ml/min/1.73 m2/ year for the stages of CKD3B→CKD4→CKD5 in parallel with the dynamics of blood levels of hemoglobin (and iron), phosphate (and calcium), albumin, as well as proteinuria is described – factors that turned out to be significant in the multiple regression model with a dependent variable – the rate of eGFR reduction (the significance of the model F=2.864; p=0.015). CONCLUSION. The obtained detailed description of the progression of CKD in a typical regional population under standard management conditions will provide the possiblity to form a group from a cohort of regular monitoring in a nephrocenter, carefully compared with an intensive management group in the prototype of a transition center based on a large inpatient dialysis center to assess the significance of the components of the proposed control and interventions program.

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The authors declare that there are no conflicts of interest present.