The importance of the metabolic syndrome (MS) in the global prevalence of chronic kidney disease (CKD) has led to numerous international studies, which showed a close association of this syndrome pathogenesis platform – insulin resistance (IR) and compensatory hyperinsulinemia (HI) – with a glomerular filtration rate (GFR) at the very early stages of nephropathy. Based on these data, it was suggested that therapy aimed at reducing IR may slow the progression of CKD. We have investigated a potential effect of IR correction on the course of nephropathy and on the CKD risk factors, associated with IR. IR correction in these studies was attended by improve of parameters such as waist circumference, body mass index, HOMA-IR, HDL, triglycerides, hyperleptinemia, adiponectin deficiency, with contemporary normalization of renal activity indexes (decrease of hyperfiltration, microalbuminuria and increase of GFR level in patients with decreased filtration capacity of kidneys). The data indicate that correction of IR has a positive effect on many risk factors of nephropathy development and can prevent or slow the progression of CKD in patients with metabolic syndrome.

THE AIM: phase III multicenter open-label randomized comparative trial on efficacy and safety of calcium polystyrene sulfonate for correction of hyperkalemia in patients with renal failure not requiring dialysis compared with low potassium diet was performed for evaluation of efficacy and safety in 5 investigational sites of Russia. PATIENTS AND METHODS: the study included patients with level of potassium in the plasma 5.5 -6.5 mmol/L. Patients received calcium polystyrene sulfonate 30 g per day during 5 days and kept a low potassium diet. Control group was treated with only low potassium diet. Primary end-point was reduction in serum potassium concentration by Day 5 of treatment compared to baseline. RESULTS: 64 patients randomized to calcium polystyrene sulfonate [n = 32] and control diet therapy [n = 32] groups. There were no differences between groups in general parameters including demographic data and the characteristics of concomitant disorders. The level of potassium observed at the visit of Day 5 of treatment reduced by 0.837 ± 0.475 mmol/L in calcium polystyrene sulfonate group and by 0.497 ± 0.409 mmol/L in the diet group; the differences between the groups were statistically significant (p = 0.0434). As a confirmation of the second end-point, ratio of reaching normal potassium level probability on Day 5 of treatment compared to diet therapy group was 1,45 (95% CI 1,04 - 2,03). CONCLUSION: calcium polystyrene sulfonate provides significant reduction of serum potassium in patients with hyperkalemia with chronic kidney disease (CKD) which are not requiring dialysis; it has the favorable safety profile and tolerability.

National guidelines. Chronic kidney disease: basic principles of screening, diagnosis, prevention and treatment approaches

The study included 105 patients (63 men and 42 women) aged 34-84 (mean 63.8 +/- 5.1) years with ischemic renal disease (IRD). All of them underwent routine medical examination, blood homocysteine was measured in 30 patients. IRD was always associated with other manifestations of disseminated atherosclerosis and cardiovascular risk factors. Plasma homocysteine increased with decreasing glomerular filtration rate (GFR) that was especially low in patients with isolated systolic arterial hypertension, smoking, and type 2 diabetes. In 34.3% of the patients, IRD associated with other chronic conditions and in 49% with cardiovascular complications and/or the development of terminal renal insufficiency. It is concluded that IRD is characterized by a large number of concomitant manifestations of disseminated atherosclerosis and a high probability of irreversible deterioration of renal functions related to cardiovascular risk factors. IRD may be associated with other chronic renal diseases and a high risk of cardiovascular complications and terminal renal insufficiency.