Keyword: CKD

ABSTRACT: Background: Chronic kidney disease (CKD) is very important to have biomarker that can be detected in time before kidney function is impaired, because it is only detected at very late stages. CD44 is a potential biomarker for kidney injury, involved in inflammation and fibrosis.
Methods: This cross-sectional study included 137 participants: The concentration of CD44 urine was measured by enzyme-linked immunosorbent assay (ELISA), and proteomic analysis was performed by mass spectrometry. For assessment, estimated glomerular filtration rate (eGFR) and 24-hour proteinuria have been monitored, while accounting for clinical and laboratory parameters. The correlation between kidney function and CD44 levels was determined using Spearman’s rank correlation.
Results: The level of CD44 in urine, as detected by ELISA, was higher in healthy controls than in CKD patients (p = 0.007). In addition, a positive correlation was observed between CD44 levels and eGFR (Spearman’s rho = 0.2808, p = 0.0052), indicating that higher CD44 levels are associated with kidney function. Proteomic analysis confirmed these results, showing a significant relationship between CD44 expression and kidney function parameters.
Conclusion: The research results demonstrate that CD44 levels in urine differ significantly between healthy individuals and CKD patients, suggesting that CD44 may be a candidate biomarker associated with kidney function. Further investigation in large-scale studies is required to confirm its clinical applicability.

ABSTRACT: Introduction: Effective follow-up of patients with kidney disease requires systematic patient registration, monitoring of kidney function, assessment of disease progression risk, and timely referral. Proper organization of medical information and reducing the risk of human error are also important. There are no published data on a functioning chronic kidney disease registry at the primary health care level in Kazakhstan. This study presents the experience of implementing a nephrology registry in Viamedis LLP city polyclinics.
Aim: To develop and implement a nephrology registry at the PHC level for data management, active identification of kidney function abnormalities, risk assessment, and improvement of patient follow-up.
Materials and Methods: The registry was developed according to current regulations of the MHRK, including Order No. 149. It includes data from the population registered at four large city polyclinics of Viamedis LLP.The registry includes patients already under follow-up and patients actively identified based on available laboratory data. For patients with previous serum creatinine results, estimated glomerular filtration rate is automatically calculated using the CKD-EPI equation and classified according to eGFR categories.The registry also includes the 4-variable Kidney Failure Risk Equation to estimate the individual 2- and 5-year risk of kidney failure. Data on eGFR, urine albumin-to-creatinine ratio, medication availability, and sodium-glucose cotransporter-2 inhibitor therapy are also recorded.
Results and Discussion: At the time of analysis, 3036 patients were under follow-up. During one month, the registry additionally identified 3051 patients outside the existing follow-up register based on previous serum creatinine results. 1462 patients (47,9%) had eGFR<60 ml. This shows a large potential for active identification of previously unregistered kidney function abnormalities and possible undiagnosed CKD requiring further confirmation and follow-up.KFRE-4 was used to assess the risk of kidney failure. Based on the 2-year risk calculation, 91 patients were identified, while 176 patients were identified using the 5-year risk calculation. These patients may require closer monitoring and timely referral to a nephrologist.The active identification results were obtained over one month. If these results are conditionally extrapolated to one year, the potential number of identified patients may increase substantially, highlighting the value of the registry as a tool for active kidney disease detection.The registry also included ACR results: 12861-A1, 1777-A2, and 67-A3 results. This allows albuminuria to be monitored over time and supports additional risk assessment.The integration of kidney function, ACR, laboratory monitoring, medication availability, and SGLT2 inhibitor therapy provided a more complete assessment of nephrology workload. Nephrology nurses supported data updating and patient follow-up, improving registry completeness.
Conclusion: The nephrology registry at the PHC level allowed a shift from monitoring only known patients to active identification of previously unregistered kidney function abnormalities. Automated CKD-EPI calculation, ACR assessment, and KFRE-4 support risk stratification and timely referral. Integration of clinical, laboratory, and treatment data improves structured follow-up and provides a more objective assessment of nephrology workload. The registry provides a basis for a proactive approach to kidney disease management at the PHC level.

ABSTRACT: Background: Despite the fact that the prevalence of CKD and its effects on health have been studied mainly in economically developed countries, the burden of this disease is even greater in developing countries. It has been established that more than 50% of deaths in patients with ESRD are due to cardiovascular causes. The objective of our study is to comparatively study the structure of cardiovascular diseases in dialysis patients at different levels of health care in Uzbekistan.
Methods: 165 dialysis patients (90 men and 75 women) were studied. The main initial diseases were chronic glomerulonephritis (n=76), diabetes mellitus (n=44), urolithiasis (n=14), chronic pyelonephritis (n=10), etc. Patients were included from 3 clinics of different administrative levels - republican (n=32), urban (n=72) and rural (n=61).
Results: CVDs were identified in 69% of the urban, 44% of the regional and 47% of the republican population. In the structure of CVD, AH, IHD and CHF prevailed in all groups. Also, in the groups of the republican and city level, CVD was more common in a combined form, while dialysis patients at the regional level had more isolated CVD pathology.
Conclusion: Patients of the urban population on dialysis more often suffer from CVD than patients receiving HD at the republican and regional levels of health care. The combined lesion of the CVS occupies a leading place in the structure of CVD in dialysis patients at both urban and national levels.