Почки играют ведущую роль в регуляции и поддержании физиологического уровня фосфора в организме. В норме уровень фосфора в сыворотке крови составляет от 0,81 до 1,45 ммоль/л [1].

AIM:To assess prevalence and risk factors of extra-coronary artery disease (peripheral artery (PA) disease (D) of lower extremities (LE), brachiocephalic arterial (BCA) stenosis (S), renal arterial (RA) S in type 1 and 2 (T1 and T2) diabetes (D) patients (P) with confirmed atherosclerosis of coronary arteries (CA).MATERIAL:100 P (48 with T2D, 18 with T1D, 34 without diabetes - PWD), with hemodynamically significant atherosclerosis of CA confirmed by coronary angiography.METHODS:All patients underwent duplex ultrasonography of PA LE, BCA, RA. Other studies included assessment of clinical characteristics and measurement of the following parameters: profibrogenic cytokines (transforming growth factor [TGF] beta1, matrix metalloproteinase 9 [MMP9], monocyte chemotactic protein-1 [MCP-1], regulated on activation normal T-cell expressed and secreted [RANTES), markers of endothelial dysfunction (von Willebrand factor [VWF], homocystein [HCYST], plasminogen activator inhibitor-1 [PAI-1], vascular cell adhesion molecule [VCAM], soluble intercellular adhesion molecules-1 [sICAM], vascular endothelial growth factor [VEGF], asymmetric dimethylarginine [ADMAD, N-terminal fragment of pro-brain natriuretic peptide (NT-pro BNP), fibroblast growth factor 23 (FGF-23), and fibrinogen.RESULTS:Portions of P with multivessel CA disease were similar in all three groups (T1D - 88.9, T2D - 85.5, WD - 82.3%). Coexistence of atherosclerosis in 2 or more vascular beds was identified in 85.3% of T2D and in 50% of WD P (p = 0.005). In T1D group 61.1 and 11.1% of P had atherosclerosis in 2 and 3 vascular beds, respectively. Levels of profibrogenic cytokines and factors of endothelial activation (RANTES, MMP-9, PAI-I, VCAM, sICAM, ADMA) were significantly higher in P with diabetes vs P WD. P with diabetes and multifocal atherosclerosis demonstrated significant increases of CRP, fibrinogen, NT-proBNP, VWF, PAI-1, ADMA, sICAM, and decrease of GFR compared with P with atherosclerosis in 1 vascular bed. Logistic regression model identified diabetes, reduced renal function, previous myocardial infarction, smoking, ADMA and fibrinogen as factors associated with presence of multifocal atherosclerosis.CONCLUSION:Coexistence of atherosclerosis in two or more vascular beds was more frequent in P with diabetes and hemodynamically significant CA atherosclerosis than in PWD. It was associated with renal and cardiac dysfunction, excessive activation of mediators of inflammation, hemostasis, and factors of endothelial damage.

Aim. To study the prognostic value of multifocal atherosclerosis (MFA) in patients with diabetes mellitus (DM) at high risk for myocardial ischemia who need coronary angiography (CAG).Subjects and methods. The investigation included 148 patients: 25 with type 1 DM (DM1), 73 with type 2 DM (DM2), and 50 without DM who had undergone CAG. Duplex ultrasound scanning of lower limb vessels and brachiocephalic and renal arteries was carried out in all the patients.Results. Involvement of two or more vascular beds was noted in 60% of the patients with DM1, in 68.4% of those with DM2, and in 34% of those without DM (p < 0.05). Regression analysis showed that the risk factors of MFA were defined to be myocardial infarction (MI) in the history (OR=2.4; p=0.02), DM (OR=3.9; p=0.0002), smoking (OR=2.4; p=0.05), elevated creatinine (OR=6.5; p=0.002) and fibrinogen (OR=6.8, p=0.004) levels. Among the DM patients, there were 26.5% of those who had achieved a main assessment criterion (a combined end point (CEP)), such as death, urgent hospitalization for heart failure, nonfatal MI, nonfatal stroke, lower extremity amputation, double creatinine levels, and achievement of end-stage renal failure during a 24-month follow-up. In patients without carbohydrate metabolic disturbances, this indicator was 12% (p=0.01). During the prospective study, a total of 6.1% of patients died in the DM group; all the patients in the non-DM group completed the study. Calculation of survival rates by the Kaplan-Meier method indicated that the DM patients with concurrent atherosclerotic lesion had achieved CEP significantly more frequently than the comparison group. Such differences were absent among the persons without carbohydrate metabolic disturbances.Conclusion. The regression analysis has shown that prior MI, DM, smoking, creatinine and fibrinogen levels are factors associated with the development of MFA in the examined groups. In the patients with DM, concurrent atherosclerosis of two or more vascular beds is an important factor for the progression of cardiovascular and renal diseases.

The present study included a total of 96 patients with long-lasting type 1 diabetes mellitus (DM1) and early (0-5) stages of chronic renal disease (CRD). Replacement renal therapy (RRT) consisted of programmed hemodialysis (PHD) and kidney transplantation (KT). Routine clinical examination was supplemented by the assessment of phosphorous and calcium metabolism indices, measurement of cardiac pathology markers, and studies of coronary artery calcification with the use of multispiral computed tomography (MSCT) of the heart with the calculation of the Agatston score index. It was shown that the impairment of the renal function was accompanied by a rise in the phosphorus, parathormone, and FGF-23 levels, increased vitamin D deficiency (with a slight deviation of its levels from the reference values in the patients at high risk of cardiovascular events treated with PHD). In the patients who had undergone KT and showed fairly good function of the renal transplant, the above parameters were similar to those of the patients with stage 0-4 CRD which suggested their normalization in case of adequate RRT during DM1. The progress of cardiovascular pathology with the deterioration of the renal function was manifested as an increase of NT-proBNP levels in parallel to the duration of CRD (r=0.304; p<0.05), decrease of the glomerular filtration rate (p=-0.540; p<0.05), and their significant correlation with the main characteristics of mineral homeostasis. The degree of coronary artery calcification was related to the patients' age, duration of DM1, and severity of arterial hypertension. The high Agatston score index and pronounced left ventricular hypertrophy in the patients following KT are supposed to reflect the irreversible character of certain cardiovascular lesions persisting despite optimal RRT and positive dynamics of phosphorus and calcium metabolism and NT-proBNP levels. It is concluded that the development and progression of renal dysfunction are associated with the disturbances of mineral and bone metabolism that promote further progress of cardiovascular pathology that is the main cause of mortality among this cohort of patients.

Disturbance of bone and mineral metabolism (BMM) is one of manifestations of chronic kidney disease (CKD), but its significance goes beyond bone disorders per se. Current discourse is as broad as to include vascular calcification, anemia and arterial hypertension, - conditions increasing mortality in patients with CKD. In this regard the active search for and development of novel approach to correction of BMM is under way. Apart from capacity to normalize calcium and phosphorus metabolism, parathyroid hormone secretion and to reduce morphologic alterations of bone tissue, modern therapeutic agents feature cardio- and renoprotective capabilities, which make them a treatment of choice for compromised BMM in CKD.

25 ноября исполняется 200 лет со дня рождения гениального русского врача Николая Ивановича Пирогова, основоположника военно-полевой хирургии, великого педагога, общественного деятеля и пламенного патриота своей Родины ? нашей национальной гордости. Пирогов, как Бурденко, как Сеченов и Павлов, как Боткин и Захарьин, как Мечников и Бехтерев, как Тимирязев и Мичурин, как Ломоносов и Менделеев, как Суворов и Кутузов ? с полным правом может быть назван новатором и воином науки.