A.E. KHRULEV¹, V.N. GRIGORYEVA¹, E.N. SOLOVYANOVA¹, N.Yu. LINEVA²

¹Nizhny Novgorod State Medical Academy, 10/1 Minin and Pozharsky Square, Nizhny Novgorod, Russian Federation, 603005

²Nizhny Novgorod Regional Clinical Hospital, 190 Rodionov Str., Nizhny Novgorod, Russian Federation, 603126 

Khrulev A. E. — Cand. Med. Sc., Associate Professor of the Department of Neurology, Neurosurgery and Medical Genetics, tel. (831) 438-95-67, e-mail: [email protected]

Grigoryeva V.N. — D. Med. Sc., Professor, Head of the Department of Neurology, Neurosurgery and Medical Genetics, tel. (831) 438-90-01, e-mail: [email protected]

Solovyanova E.N. — Cand. Med. Sc., Associate Professor of the Department of Internal Diseases named after V.G. Vogralik, tel. (831) 438-91-36, e-mail: [email protected]

Lineva N.Yu. — Head of the Department of Dialysis and Gravitational Surgery of Blood, tel. (831) 438-93-49, e-mail: [email protected]

 Cerebral vascular disorders in patients with chronic kidney disease (CKD) are discussed in the article. The main pathogenic mechanisms of damage to cerebral vessels in patients with CKD are described. The main risk factors of cerebral vascular disorders, as well as strategies of their correction in patients with CKD are discussed in detail. Attention is drawn to the need for early diagnosis and timely correction of glomerular filtration rate and albuminuria, arterial hypertension, atherosclerosis and dyslipidemia, vascular calcification, β2-macroglobulinemia and cerebral amyloid angiopathy. The issues of treatment of patients with CKD, based on recent national and international guidelines, are considered.

Key words: chronic kidney disease, risk factors, cerebral vascular disorders, stroke, transient ischemic attack, chronic cerebral ischemia, subarachnoid hemorrhage, treatment.

REFERENCES

1. K/DOQI Clinical Practice Guidelines for Chronic Kidney Disease: Evaluation, Classification and Stratification. Amer. J. Kidney Dis, 2002, no. 39 (2), pp. 5-266.
2. Ermolenko V.M. Khronicheskaya pochechnaya nedostatochnost’. Nefrologiya, pod red. I.E. Tareevoy [Chronic renal failure. Nephrology. Ed. by I.E. Tareeva]. Moscow: Meditsina, 1995.
3. Stetsyuk E.A. Sovremennyy gemodializ [Modern hemodialysis]. Moscow: MID, 1998.
4. John T. Dandirdas, Kunig P., Neyer U. et al. Neurological disease of Renal Failure. Neurology and general medicine, 2002, no. 3, pp. 131-142.
5. Sapunova D.A. Chronic kidney disease — a modern supranosological concept. Meditsinskiy vestnik, 2013, no. 32 (645), p. 10 (in Russ.).
6. Rogova I.V., Fomin V.V., Damulin I.V. Features of the formation of cognitive disorders in chronic kidney disease. Klinicheskaya farmakologiya i terapiya, 2011, no. 20 (5), p. 65 (in Russ.).
7. Clase C., Garg. A., Kiberd B. Prevalence of low glomerular filtration rate in non-diabetic Americans: Third National Health and Nutrition Examination Survey (NHANES III). J. Am. Soc. Nephrol, 2002, no. 13 (5), pp. 1338-1349.
8. Dobronravov V.A., Smirnov A.V., Dragunov S.V. et al. Epidemiology of chronic renal failure in the North-West region of Russia: on the way to the creation of the chronic renal disease register. Terapevticheskiy arkhiv, 2004, no. 76 (9), pp. 57‐61 (in Russ.).
9. Smirnov A.V., Kayukov I.G., Esayan A.M. et al. Preventive approach in modern nephrology. Nefrologiya, 2004, no. 8 (3), pp. 7‐14 (in Russ.).
10. Bikbov B.T., Tomilina N.A. The state of substitution treatment of patients with chronic renal insufficiency in the Russian Federation in 1998-2007. (Analytical Report on the Russian Register of Replacement Renal Therapy). Nefrologiya i dializ, 2009, no. 11 (3), pp. 144‐233 (in Russ.).
11. Nathan E., Penersen S.E. Dialysis encephalopathy. Acta. Pediat. Scand, 1980, no. 69, pp. 793-796.
12. Raskin Neil H. Neurological Aspects of Renal Failure. Neurology and general medicine. Ed. by M.J. Aminoff. 3rded, 2001. Pp. 231-246.
13. Statinova E.A. Lipid disorders in patients with discirculatory encephalopathy who are on treatment with programmed hemodialysis. Neyronauki: teoretichni tak linichni aspekti, 2008, no. 1 (4), pp. 101-104.
14. European Renal Association (ERA-EDTA) Registry. Nephron, 2001, p. 54.
15. Kawamura M., Fijimoto S., Hisanaga S. et al. Incidence, outcome and risk factors of cerebrovascular events in patients undergoing maintenance haemodialysis. Am. J. Kidney Dis, 1998, no. 31, pp. 991-996.
16. Volker W., Lin T., Sudtida S. et al. Atrial fibrillation in hemodialysis patients: clinical features and associations with anticoagulant therapy. Kidney International, 2010, no. 77, pp. 1098-1106.
17. Seliger S.L., Gillen D.L., Longstreth W.T. et al. Elevated risk of stroke among patients with end-stage renal disease. Kidney Int, 2003, no. 64, pp. 603-609.
18. Perk J., De Backer G., Gohlke H. et al. European Guidelines on cardiovascular disease prevention in clinical practice (version 2012). Eur. Heart J, 2012, no. 33, pp. 1635-1701.
19. Nikolaev A.Yu. Features of dialysis hypertension. Nefrologiya, 2000, no. 1 (4), pp. 95-97 (in Russ.).
20. Natsional’nye rekomendatsii. Khronicheskaya bolezn’ pochek: osnovnye printsipy skrininga, diagnostiki, profilaktiki i podkhody k lecheniyu [National recommendations. Chronic kidney disease: the basic principles of screening, diagnosis, prevention and treatment approaches]. Saint Petersburg: Levsha, 2012.
21. London G.M., Guerin A.P., Marchais S.J. et al. Cardiac and arterial interaction in end-stage renal disease. Kidney Int,1996, no. 50, pp. 600-608.
22. Shutov A.M., Kondrat’eva N.I., Speranskaya S.M. Arterial compliance in patients with chronic renal failure and hypertensive disease with a preserved renal function. Nefrologiya, 2002, no. 1 (6), pp. 35-39 (in Russ.).
23. Kovesdy C.P., Bleyer A.J., Molnar M.Z. et al. Blood pressure and mortality in US veterans with chronic kidney disease: a cohort study. Annals of internal medicine, 2013, no. 4 (159), pp. 233-242.
24. Clinical practical recommendations KDIGO on conducting dyslipidemia in patients with chronic kidney disease KGIGO. Nefrologiya i dializ, 2015, no. 4 (17), pp. 371-417 (in Russ.).
25. Smirnov A., Kozlov V. Clinical manifestations of atherosclerosis in patients on hemodialysis. Nefrologiya, 1998, no. 5 (2), pp. 68-76 (in Russ.).
26. London G.M. Vascular disease and atherosclerosis in uremia. Blood Purf, 2001, no. 19, pp. 139-142.
27. Clinical practical recommendations for the diagnosis, evaluation, prevention and treatment of mineral and bone disorders in chronic kidney disease (ICD-CKD) (Summary KDIGO). Nefrologiya i dializ, 2011, no. 1 (13), pp. 8-12 (in Russ.).
28. Korotkiy D.V., Gerasimchuk R.P., Makeeva T.I. et al. Secondary hyperparathyroidism and mitral-aortic calcification at pre-dialysis stages of CKD and with renal replacement therapy. Nefrologiya i dializ, 2011, no. 2 (13), pp. 89-95 (in Russ.).
29. Ochiai H., Uezono S., Kawano H. Factors affecting outcome of intra cerebral hemorrhage in patients undergoing chronic hemodialysis. Ren. Fail, 2010, no. 8 (32), p. 923.
30. Jardine A.G., Elliott H.L. ACE inhibition in chronic renal failure and in the treatment of diabethic nephropathy: focus on spirapril. Cardiovasc. Pharmacology, 1999, no. 34 (Suppl. 1), pp. 31-34.
31. Levey A.S., Beto J.A., Coronado B.E. et al. Controlling the epidemic of cardiovascular disease in chronic renal disease: what do we know? What do we need to learn? Where do we go from here? National Kidney Foundation Task Force on Cardiovascular disease. Am. J. Kidney Dis, 1998, no. 32, pp. 853-906.