Механизмы потери альбумина на фоне применения современных методов заместительной почечной терапии


DOI: https://dx.doi.org/10.18565/nephrology.2023.2.79-87

Литвинов А.С., Гасанов М.З., Кузнецова Ю.В., Гергия С.Р., Шевченко С.В.

1) ООО «Балтийская Медицинская Компания», Владикавказ, Россия; 2) Партнерство с ограниченной ответственностью «Metaco LLP», Лондон, Великобритания; 3) ФГБОУ ВО «Ростовский государственный медицинский университет» Минздрава РФ, Ростов-на-Дону, Россия; 4) ООО «ДЦ Нефрос-Дон», Ростов-на-Дону, Россия
В статье рассматриваются вопросы заместительной почечной терапии (ЗПТ) с учетом новейших знаний в области физики
и химии полимерных диализных мембран. Приведены существующие и исторические сведения о классификации мембран для гемодиализа. В обзоре также рассматриваются вопросы классификации диализных мембран, исходя из целесообразности их применения для конкретной клинической ситуации, с целью достижения более эффективного гемодиализа и его модификаций, а также увеличения безопасности процедуры и снижения эпизодов реакции бионесовместимости. Оценено влияние потери альбумина при применении различных методов экстракорпоральной аппаратной детоксикации и перитонеального диализа на качество жизни и выживаемость пациентов с терминальной почечной недостаточностью. Описаны механизмы потери белков при ЗПТ путем адсорбции на мембране гемодиализатора, конвективного переноса и элиминации в диализат. Кроме того, представлены возможности анализа адсорбированных белковых фракций при различных патологических состояниях. Обсуждаются вопросы потенцирующего влияния гипоальбуминемии в качестве независимого фактора риска неблагоприятных исходов у пациентов, получающих ЗПТ. Определение уровня альбумина и его потерь в ходе процедур замещения утраченной функции почек представляется рутинным методом, позволяющим косвенно контролировать основной и энергетический обмены, от активности которых зависит прогноз лечения методами экстракорпоральной детоксикации.
Ключевые слова: синтетические диализные мембраны, адсорбция белковых фракций, коэффициент просеивания, мембрана с высокой отсечкой, мембрана со средней отсечкой, гемодиафильтрация, перитонеальный диализ, терминальная почечная недостаточность, гемодиализ, хроническая болезнь почек, альбумин
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Об авторах / Для корреспонденции

Литвинов Александр Сергеевич – к.м.н., ведущий научный специалист; главный врач ООО «Балтийская Медицинская Компания».
Адрес: 362047 Республика Северная Осетия-Алания, Владикавказ, ул. Морских Пехотинцев, 15 «Б»; e-mail: dirge@yandex.ru. ORCID: 0000-0001-5251-145X
Гасанов Митхат Зульфугар-оглы – к.м.н., доцент ФГБОУ ВО Ростовский государственный медицинский университет Минздрава РФ, кафедра внутренних
болезней №1. Адрес: 344022 Россия, Ростов-на-Дону, пер. Нахичеванский, 29; e-mail: mitkhat@mail.ru. ORCID: 0000-0001-5856-0404
Кузнецова Юлия Витальевна – студентка ФГБОУ ВО Ростовский государственный медицинский университет Минздрава РФ. Адрес: 344022 Россия, Ростов-на-Дону, пер. Нахичеванский, 29; e-mail: ul.kuznetsova04@mail.ru. ORCID: 0000-0002-5740-3009
Гергия Саид Романович – врач-нефролог ООО «ДЦ Нефрос-Дон». Адрес: 344000 Россия, Ростов-на-Дону, ул. Текучева, 22; e-mail: boss.gergiya@mail.ru.
ORCID: 0009-0004-3799-0674
Шевченко Сергей Владимирович – врач-терапевт ФГБОУ ВО «Ростовский государственный медицинский университет» Минздрава РФ.
Адрес: 344022 Россия, Ростов-на-Дону, пер. Нахичеванский, 29; e-mail: shevchenko19967@mail.ru. ORCID: 0000-0002-0151-0761


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