Background: Chronic kidney disease (CKD) is a serious medical as well as socioeconomic problem in the Russian Federation. Competent primary and secondary prevention of CKD, along with the availability of suitable renal replacement therapy (RRT), are the key factors for reducing mortality, incidences of complications, rate of disease progression, and cost of treatment in the human population. Problem: Since 1998, particularly during 2010-2015, there is an increase in the provision of the RRT in the Russian Federation. At present, the available therapy is unable to meet the real need, which is related both to the high prevalence of patients with CKD in the population and the current slow rate of RRT development. Insufficient secondary prevention, shortage of qualified personnel, and delayed primary diagnosis lead to a high prevalence rate of end-stage CKD and thus giant treatment costs of the condition. Purpose: This study aimed to analyze the RRT structure by studying the key parameters that describe the national situation of RRT during the last two decades: 1998-2018 in the Russian Federation. Conclusion: The Russian system of RRT has been constantly developing since 1998, and inequality in access to the RRT system is gradually decreasing among different regions. Some parameters still need improvements, such as availability of hemodialysis and peritoneal dialysis, cost of consumables, complications related to drug therapy for end-stage CKD patients, and an better assessment of the real statistics of CKD patients at pre-dialysis and dialysis stages in the Russian Federation.

METHODS: During living-donor renal transplantation procedure, subcutaneous fat biopsies were obtained from the abdominal wall at the incision site from donors and recipients for isolation of arteries (Ø230 mm) used to assess endothelial and smooth muscle function using wire myography.In vivo RHI was measured using the EndoPAT.RESULTS: Recipient and donor groups were of similar age (mean 6 SEM; years: 46615; n=28 vs. 50612; n=28).During in vitro isometric force measurements, arteries from recipients (n=11) demonstrated similar contractions to those obtained in arteries from donors (n=12) after single stimulation with KCl at 119 mM (mN/mm: 5.364 vs. 6.064) and agonists phenylephrine at 10 mM (% of max KCl contraction: 8265 vs. 8866).The concentration response curves to norepinephrine were similar between the groups (e.g. at 10mM: 109610; n=11 vs. 10667; n=12) and the basal tension did not differ either.The endothelium-dependent dilatation to bradykinin (BK) did not differ between groups (% max dilatation at 1mmol: 7764, n=9 vs. 7364; n=12) and sodium nitroprusside-induced relaxation was also similar (at 100 mmol: 7964 n=11; vs. 7965; n=12).There were no differences between the responses studied in the subgroup of recipients on RRT or not.Nitric oxide synthase and cyclooxygenase inhibition had no effect on any functional parameter in arteries from any group.RHI reflecting endothelial function in vivo did not differ between recipients and donors (2.260.5;n=20 vs. 2.460.6;n=23).There was a tendency towards positive correlation between RHI and BK relaxation, but it did not reach significance (rho=0,44; p=0,08; n=17).RHI did not correlate with any of other functional parameters studied.CONCLUSIONS: The present study found no differences between uremic and control arteries regarding peripheral vasomotor function in resistance arteries.The tendency towards a positive correlation between endothelial function in vitro and RHI in vivo requires further experimental investigations including additional subjects.

AIM: Combination of cardiovascular and renal disease is currently viewed as a unified cardiorenal syndrome (CRS). The aim of our study was to assess the CRS prevalence and risk factors associated with left ventricular hypertrophy (LVH) in patients with pre-dialysis stages of chronic kidney disease (CKD) of various etiology. MATERIALS AND METHODS: We enrolled 172 patients with CKD to participate in this study. First group consisted of 83 patients with nondiabetic CKD at 2nd through 4th stage (mean age 46-15 years, 51% male and 29% female). Mean glomerular filtration rate (GFR) was 37.2 ml/min (33.9-41.4 with 95% CI); creatinine plasma clearance was 2.9 mg/dl (2.6-3.2). Second group consisted of 89 patients with type 2 diabetes mellitus (T2DM) and CKD at 1st?2nd stage (40% male and 60% female) with albuminuria (mean age 57.3-7.1 years). Duration of diabetes in this sampling was 10.4-7.1 years. All patients underwent standard clinical examination, supplemented with echocardiography to evaluate the influence of general and CKD-related risk factors for LVH. RESULTS: LVH was diagnosed in 37.3% of non-diabetic patients with CKD at 2nd through 4th stage. Aside from classic cardiovascular riskfactors (including age, gender, arterial hypertension, family history of cardiovascular diseases, hypercholesterolemia), we observed theimpact of kidney-related factors (anemia, plasma creatinine, disturbance of calcium-phosphorus metabolism). CKD progression wasassociated with elevation in the incidence of concentric and eccentric LVH). Patients with T2DM were diagnosed with LVH in 36% ofcases. Increased myocardial mass correlated with plasma levels of uric acid, HbA1c, obesity and albuminuria. There was also a firmassociation between diabetic nephropathy, left ventricular myocardial remodelling and a history of cardiovascular events. CONCLUSION: In patients with diabetes mellitus and CKD cardiorenal syndrome develops at pre-dialysis stages due to both classic and kidney-related cardiovascular risk factors.

The article considers such aspects of educational institutions networking as prerequisites, main characteristics of a network organization, models of interaction between educational institutions and regional aspects of creating a common educational space. The author gives examples of priority networking projects of professional education institutions, as well as their goals, objectives, and distinctive features of these projects.