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AIM: To evaluate peculiarities of the course of cardiac failure (CF) in initiation of hemodialysis therapy (HT) in patients with terminal chronic renal failure (CRF) and 24 months after HT; to elucidate CF causes late in HT. MATERIAL AND METHODS: Cardiohemodynamics was studied in 152 patients with terminal CRF during 2 years of HT. RESULTS: At initiation of HT, cardiohemodynamics was characterized by hyperkinetic syndrome, high total peripheral resistance, weak left ventricular systolic function, diastolic dysfunction. Chronic HT for 2 years led to attenuation of hyperkinetic syndrome, improvement of left ventricular systolic function, highly increased bypass blood flow along the arteriovenous fistula. The correction of the blood flow along the arteriovenous fistula arrested manifestations of CF in all the patients. CONCLUSION: Drugs with positive inotropic action are contraindicated in patients with terminal CRF on chronic hemodialysis having CF. Regular measurements of blood flow along the arteriovenous fistula are recommended for early detection and correction of increased bypass blood flow.

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In examination of patients with chronic renal failure (CRF) at glomerular filtration rate below 30 ml/min and blood serum ion concentration within limits of normal values hyperosmia has been found. Under the natural regimen essential differences have been revealed neither in variation limits of renal excretion of ions nor osmotically active substances in CRF patients as compared with healthy controls. Diuresis correlated with renal excretion of osmotically active substances. It is shown that a decrease in reabsorption of osmotically active substances depends on secretion and excretion of prostaglandin E2. A suggestion is made about the role of prostaglandins in regulation of renal tubular function at terminal CRF stages.

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Concentrations of uremic toxins in the blood and jejunal juice of 72 patients with chronic renal failure (CRF) were studied as well as morphologic changes in biopsies from jejunal mucosa and submucosa, activity and location of acid and alkaline phosphatase as markers of intracellular and transmembrane transport. It was found that maximal excretion of uremic toxins in the jejunum occurs in CRF stage IIA and IIB. In terminal CRF excretion of uremic toxins delays from their concentration in the blood. This process is related with changes in enzymic processes. Histologically, all the examinees exhibited signs of chronic enteritis.

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It was found that there is unbalance between accumulation of lipid peroxidation (LPO) products and antioxidant potential in blood plasma and red cells from chronic glomerulonephritis patients with renal dysfunction. The unbalance cannot be corrected by standard conservative therapy. Oral sorbents result in normalization of the plasma abnormalities, but a long-term intake of coal depletes antioxidant defense which is likely to occur because of low plasma tocopherol levels. Vitamin E deficiency aggravates LPO adverse effects. It is recommended to combine long-term course of enterosorbents with parenteral antioxidant drugs.

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To specify factors determining the intensity of uremic intoxication, 86 patients with chronic glomerulonephritis were examined without regard for exacerbation at different stages of chronic renal failure. Microcolumn gel chromatography was used to measure the content of medium-size molecules in the blood serum, urine, gastric and intestinal juice of the patients and 22 mongrel dogs before and after bilateral nephrectomy. It has been established that as the mass of acting nephrons decreases, the content of "medium-size" molecules in the blood serum and intestinal juice rises, being unchanged in gastric juice. At the same time the urinary clearance of the given group of substances declines. It is assumed that in stage I chronic renal failure, enhancement of the excretion of "medium-size" molecules in the proximal third of the small intestine is made for by hyperfiltration of intact nephrons. The appearance of the clinical symptomatology in stage II and III chronic renal failure is determined by intensification of absorption of uremic toxins by the intestine, associated with a fall of their urinary clearance. The necessity of early administration of the low-protein diet combined with enterosorbents is stressed.

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The paper provides the results of 32 experiments on 22 mongrel male dogs with a view to measuring creatinine levels in the lumen of various intestinal segments before and after bilateral nephrectomy and evaluating the effects the enterosorbent brand SKN administered into isolated portions of the intestinal tube on alteration of intraluminal concentrations of creatinine, serum creatinine, and "middle-sized" molecules. Four parts of the intestine were identified: (1) proximal; (2) middle and (3) distal portions of the small intestine, and (4) the large intestine up to the anal sphincter. Two days following bilateral nephrectomy, creatinine levels were increased in the proximal, middle, distal portions of the small bowel and in the large bowel by 18, 11, 5, and 1.4 times, respectively, as compared to the baseline creatinine concentration in the intestinal parts mentioned. The administration of the enterosorbent into the different intestinal parts revealed that with its 6-hour exposure, the most potent effect (lower concentrations of creatinine and "middle-sized" molecules in serum) was observed in the proximal portions of the small bowel. This phenomenon is likely to be attributable to greater vascularization and the maximal creatinine and "middle-sized" molecule concentration in these intestinal portions. With this, it was shown that the higher baseline concentrations of serum creatinine and "middle-sized" molecules were, the more actively they absorbed on the charcoal enterosorbent brand SKN in the intestine.

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The paper is concerned with materials characterizing physicochemical properties of haemosorbents of varying grades. Adsorption of different uraemic toxins was studied. The possibility of microembolization of internal organs and tissues with haemosorbent particles was explored in the course of prolonged treatment with the use of haemosorption. Different approaches to connecting the sorption column to the dialyzer were examined to disclose an optimal variant. The authors report the results of applying haemosorption in patients who had received haemodialysis therapy to prevent complications. The blood response to the prolonged haemosorption treatment was analyzed. It is recommended that long-term (6-7 hours) sessions of haemosorption might be performed using carbons having high sorption capacity.

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The water flow according to the osmotic gradient increased under the action of 1 mU/ml of antidiuretic hormone (ADH) from 0,049 +/- 0.017 to 1.31 +/- 0.29 mcl/cm2 min in the presence of hemosorbent SKN in the solution of the frog bladder serous membrane and from 0.054 +/- 0.015 to 0.67 +/- 0.15 mcl/cm2 min without a sorbent. The effect of polyethylene glycol 400 hyperosmotic solution on the water, cAMP and theophylline penetration was not intensified after hemosorbent use. ADH inhibitor-binding substances are present in the blood serum. The data obtained allow one to conclude that ADH enhances the water penetration, stimulating at the same time the release of the inhibitor, lowering its interaction with the receptor. Such a selfregulation is absent in the presence of hemosorbent, absorbing ADH inhibitor.

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Physico-chemical characteristics of blood from patients with chronic kidney insufficiency were studied by means of ionization equilibrium in whole blood, blood plasma and erythrocytes suspended in physiological solution. The curves of ionization equilibrium were registered by changes of pH under conditions of controlled heating (58 degrees) of blood, blood plasma and erythrocytes. Electric charge of proteins in blood plasma, erythrocytes and, especially, in whole blood was decreased in patients with chronic kidney insufficiency as compared with healthy persons. In the patients with kidney impairment, as distinct from healthy persons increase in ion strength improved the blood physico-chemical properties and an artificial elevation of hematocrit decreased the electric charge of blood and deteriorated the immunological properties of blood plasma proteins.

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