MEASURES TO BE TAKEN IN EARLY DIAGNOSIS OF CHRONIC KIDNEY DISEASE

Аннотация

Chronic kidney disease (CKD) is a super-nosological concept that combines a complex of diseases with common pathogenesis, symptoms and outcomes. Pathology affects 13.4% of the population and is 3 times more common in people over 60 years of age than in patients of working age. The incidence of CKD in patients with heart disease is about 26%. Frequent occurrence, irreversible nature, difficulties in treatment and a significant impact on the quality of life of a person - all this determines the relevance of the problem in modern nephrology. Risk factors for the development of chronic kidney disease, in addition to kidney disease, are arterial hypertension, diabetes mellitus, atherosclerosis, obesity, metabolic disorders, especially high cholesterol and uric acid in the blood. There are simple and accessible methods for early diagnosis of kidney disease, but in the vast majority of patients the disease is detected at a terminal (final) stage, when the opportunity for effective treatment has already been missed. Keywords. Chronic kidney disease (CKD), arterial hypertension, diabetes, atherosclerosis, obesity, metabolic disorders, Glomerular filtration rate (GFR). Chronic kidney disease (CKD), including. Stages characterized by a persistent decline in glomerularfiltration rate (GFR)and therefore associated with theworst long-term prognosis, are increasingly common inthe general population,especially among the elderly. The results of large-scale epidemiological studies show that CKD is especially common in older people [1, 2]. Therefore, the relationship between CKD and aging has become the main theme of WorldKidney Day 2020[3]. The sharp increase in the incidence of CKD is primarily associated with the prevalence of common risk factors in the population (arterial hypertension, diabetes mellitus, obesity) [4]. A large population-based analysis of NHANES and KEEP, including a total of 32,555 subjects, and a 5% sample of the Medicaid database (1,236,946 cases) [5] found that a persistent decrease in GFR 1.1 mg/dL, the mortality rate was significantly higher than 98,7:ROTCAFTCAPMI .SECNEICSLACIDEM ,5202, enuJ,5emuloV gro.srehsilbupcimedaca.www in individuals with a serum creatinine level < 1.1 mg/dL (66.7 vs. 34.2%, p = 0.004). The mortality rate, estimated by the value of endogenous creatinine clearance, on the other hand, did not differ significantly between groups differentiated by the initial level of creatinine, nor did there appear to be any differences in the rate of development of SCK, estimated by the values ​ ​ creatinine, urea concentration, and also GFR calculated using the MDRD formula. Therefore, the results of this study do not allow us to doubt that the presence of SCK significantly worsens the prognosis of patients, but indicate that focusing only on creatinineemia, making a diagnosis and predicting its course may not be entirely correct. Of course, the optimal methods for assessing GFR in the elderly require further refinement and standardization;one of the mostpromising is thecalculation of this indicatorusing theSBK- EPIformulabased ontheresults ofdetermining serum creatinineand cystatin Clevels [7]. It should be borne in mind that, all other things being equal, complications of almost any disease are most pronounced in elderly patients with SBK and their course is unfavorable. Thus, inparticular, it was found that albuminuria and a decrease in estimated GFR in elderly patients with type 2 diabetes are independent predictors of frontal lobe dysfunction of the brain [8]. Elderly patients with SBK have a different worst blood pressure control: as they age, they The frequency of uncontrolled isolated systolic arterial hypertension, which is considered one of the most unfavorable prognostic forms of arterial hypertension, increases. Thedetermining factors ofuncontrolled arterial hypertension for thiscategory of patients are also stages 4-5 SBK, obesity, and type 2diabetes mellitus[9]. It should be noted that the leading role in the formation of chronic renal failure is somewhat different from those that play. In addition, the course and outcome of SBC in the elderly, as well as the factors determining them, are characterized by certain features, which, as a rule, lead to a significant deterioration in the prognosis, all other things being equal, including. kidney. Immunoinflammatory damage t