INDICATORS OF WATER METABOLISM AND BLOOD OSMOLARITY IN PATIENTS WITH ACUTE DECOMPENSATION OF CHRONIC HEART FAILURE BEFORE AND AFTER TREATMENT
Aim. Comparative evaluation of indicators of water metabolism and blood osmolarity in patients with acute decompensation of chronic heart failure (CHF) before and after treatment. Material and methods. 100 patients (54 (54,0%) men, 46 (46,0%) women) with CHF before and after the use of standard therapy and dialysis technologies were examined. The control group consisted of 30 practically healthy men and women. Patients with acute decompensation of CHF, depending on the type of standard therapy and dialysis treatment methods, were divided into 3 groups: 1 - 34 people who received standard therapy according to the recommendations of the European Society of Cardiology (ESC) (2016, 2018) and the Russian Society of Cardiology (RSC) (2016) and protocols approved by the Ministry of Health and Social Protection of Population of the Republic of Tajikistan (2015); 2 - 66 patients conditionally divided into 3 subgroups: in 2.1 subgroup 36 patients underwent standard therapy in combination with isolated ultrafiltration (IUF); in 2.2 subgroup 20 patients underwent standard therapy in combination with hemodialysis (HD) and ultrafiltration (UF); in 2.3 subgroup 10 patients underwent standard therapy in combination with prolonged hemo-diafiltration (PHDF). General clinical (complaints, anamnesis of life and disease according to CHF, previously received treatment, etc.); physical (checkup, palpation, auscultation), laboratory (determination of water-electrolyte balance, osmolarity of blood) and instrumental (lung radiography, ultrasound of the abdominal cavity, kidneys, pelvis, dopplerometry) research methods were carried out. The study and analysis of water metabolism, osmolarity and central venous pressure (CVP) were carried out according to generally accepted formulas and calculations. Results. After treatment, patients with acute decompensation of CHF showed positive dynamics of normalization of the main parameters of water metabolism, more pronounced in group 2. The effectiveness of treatment directly depended on many factors, including the type of applied dialysis membranes, and the duration of the procedure. During IUF using low flux dialyzers (UFC 5,5 ml/h mm Hg, CoA <700), the required volume of fluid, hydrophilic toxic substances of low molecular weight, and some electrolytes are effectively removed. The use of low flux with a high mass transfer coefficient (highCoA) (UFC 8.5 ml/h mmHg, CoA >700) is more effective compared to the previous version of the dialyzer, because additionally eliminated part of the hydrophilic oligopeptides of medium molecular weight. Both dialyzers are ineffective against hydrophobic and amphiphilic toxic low-, medium- and high-molecular components, hydrophilic medium- and high-molecular substances, as well as violations of the blood acid-base balance. HD in combination with UF, as well as PHDF using high-flow (hig hflux) (UFC 33 ml/h mmHg, CoA>700) dialyzers and hemofilters (UFC 55 ml/h mmHg, CoA >700,) are more effective than IUF, however, both dialyzers are not effective against hydrophobic and amphiphilic high-molecular components. HD+UF and PHDF methods are available in specialized departments, are more expensive than IUF, since the procedure requires dialysate, bicarbonate, etc. Conclusion. Interdependent processes of disorders of the functional state of the heart, kidneys and water metabolism are noted in patients with acute decompensation of CHF. They were characterized by hypervolemia, an increase in the volume of total water, redistribution of water intra- and extracellular sectors, an increase in interstitial volume due to fluid accumulation, as well as an increase in osmolarity and a decrease in colloid osmotic pressure, against the background of a decrease in the functional state of the kidneys. This is one of the pathogenetic mechanisms of the development of acute decompensation of CHF, progressing as the severity of HF increases. The choice of the method of extracorporeal correction of acute decompensation of CHF depends on many factors, including the functional state of the parameters of general hemodynamics, the required UV time, etc.