[Prevalence and prognostic value of gastroenterological manifestations of COVID-19: data from the Russian University Clinic].

AIM: Assessment of the prevalence and prognostic value of gastroenterological manifestations in patients with COVID-19. MATERIALS AND METHODS: A single-center retrospective cohort study was carried out. Only cases with laboratory confirmed detection of SARS-CoV-2 virus RNA using polymerase chain reaction in oro-/nasopharyngeal smear samples were subject to analysis. Patients with documented (according to anamnestic data and/or according to examination data during hospitalization) organic pathology of the gastrointestinal tract (GIT) and/or hepatobiliary system, malignant neoplasms of any localization, as well as pregnant patients were excluded from the general register of retrospective data. The final cohort was divided into two groups depending on the presence of gastrointestinal symptoms: COVID-19 with gastrointestinal symptoms (cases) and COVID-19 without gastrointestinal symptoms (control). RESULTS: The final sample consisted of 3764 patients, including 2108 (56%) women and 1656 (44%) men. The average age of the subjects included in the analysis was 58.0 years (95% confidence interval CI 48.663.0). In the study cohort, gastroenterological manifestations (alone or in combination) were recorded in 885 (23.51%) patients. Calculation of the odds ratio (OR) of unfavorable and lethal outcomes between the analyzed groups showed that the presence of gastroenterological symptoms significantly increases the chances of lethal outcome in a cohort of elderly and senile patients (OR 1.6817, 95% CI 1.03352.7364; p=0.0364), determines a higher risk of hospitalization or transfer to the intensive care unit (OR 1.2959, 95% CI 1.05471.5922; p=0.0136), development of acute respiratory distress syndrome (OR 1.5952, 95% CI 1.31641.9329; p0.0001), as well as the need for mechanical ventilation (OR 1.2849, 95% CI 1.0771.5329; p=0.0054). CONCLUSION: The present study has demonstrated that gastroenterological symptoms are detected in about one in four patients infected with the SARS-CoV-2 virus and multiply the risk of adverse and life-threatening complications of COVID-19.

[Decreased Serum Levels of Klotho Protein in Chronic Kidney Disease Patients: Clinical Imortance].

Objective: To determine the role of serum Klotho (s-Klotho) protein levels changes in patients with different stages of chronic kidney disease (CKD). Methods: The study involved 130 patients with CKD stages 1­5D (mean age ­ 41±6.7 years). Serum levels of parathyroid hormone (PTH), calcium, phosphorus and s-Klotho protein (ELISA method) at baseline and after 1 year of follow-up were examined in all the patients so as the blood pressure (BP), including central (aortic), pulse wave velocity ­ with the help of «Sphygmоcor¼ (Australia), echocardiography, radiography of the abdominal aorta in a lateral projection were also performed. Results: Ehen comparing the s-Klotho levels in patients with different CKD stages, it was found that the level change associated with the reduction of glomerular filtration rate (GFR) ahead of phosphorus and PTH increase in serum, stared at 3A CKD, whereas hyperphosphatemia and PTH increase started at 4­5 CKD stages. According to ROC analysis, decreasing of s-Klotho levels below 387 pg/ml was indicated a calcification risk of abdominal aorta increased with an 80% sensitivity and 75% specificity. In addition, a strong negative relationship of low s-Klotho levels and heart remodeling was found. When comparing the patients with hypertension who were receiving antihypertensive monotherapy, the highest serum levels of Klotho protein were observed in those of them whose target blood pressure level was achieved primarily through Angiotensin II Receptors Blockers (ARB), compared to those who was administered another drug group (p<0.01) or has not reached the target blood pressure level (p=0,008). Conclusion: The change of serum Klotho levels (decrease) in CKD progression is associated with the degree (increase) of cardiovascular calcification and remodeling (the development of left ventricular hypertrophy, and cardiomyopathy) and it can be seen as an early independent marker of the cardiovascular system lesions in CKD. Our preliminary data of the effect of blood pressure correction on s-Klotho levels may indicate the possibility of drug maintaining serum Klotho levels and it requires further research.

[Cognitive impairment in predialysis stages of chronic kidney disease].

OBJECTIVE: To study the development and progression of cognitive impairment (CI), its risk factors and relationship with vascular-wall remodeling in patients with chronic kidney disease (CKD), stages I-IV. MATERIAL AND METHODS: Fifty-one patients, aged 53±10 years, including 20 with CKD, stages I-II, 20 with CKD, stage III, and 11 with CKD, stage IV, were enrolled. Frequency, severity and character of CI were studied using neuropsychological tests for assessment of global mental status, short-term and delayed memory, frontal lobe functions. Standard laboratory examinations, echocardiographic study, 24h arterial blood pressure monitoring, measurement of the thickness of carotid intima-media complex, pulse-wave velocity and augmentation index, brain MRI study were carried out. RESULTS: CI was found in 68% of patients, including 35% with CKD, stages I-II, and 90.3% with CKD, stage IV. The severity of CI was higher in patients with CKD, stages III-IV, compared to those with stages I-II (p<0.001). CKD predicted the development of CI (OR 27.32, 95% CI 4.3-72.9, р<0.001). MRI revealed the focal lesions of the white matter in 30% of patients, leukoaraiosis in 23.3%, lateral ventricular dilatation in 50%, expressed dilatation in the sulci of brain hemispheres in 10%. There was a relationship between CI and male sex, hyperhomocysteinemia, anemia, abdominal obesity, left ventricular myocardial hypertrophy and age. The frequency and severity of CI was associated with the signs of atherosclerotic lesions of common carotid arteries and indices of arterial rigidity. CONCLUSION: The more increased the CKD severity, the higher the severity of CI. The dysfunction of frontal lobes plays a key role in the development of CI in patients with CKD, stages III-IV. CKD, stages III-IV, is an independent predictor of CI in people in predialysis stages.

[Chronic kidney disease and vascular dementia].

The paper shows the value of chronic kidney disease as a population-wide determinant of vascular dementia, including moderate cognitive impairments. It discusses the role of risk factors of cardiovascular events, including those associated with chronic kidney disease, in the development of vascular dementia and moderate cognitive impairments.

[Specific features of cognitive impairments in patients with predialysis chronic kidney disease].

AIM: To study the specific features of cognitive impairments (CI) in patients with predialysis chronic kidney disease (CKD). SUBJECTS AND METHODS: Examinations were made in 51 patients aged 52 +/- 10 years with CKD, including 20 patients with Stages I-II CKD (glomerular filtration rate (GFR) > or = 60 ml/min/1.73 m2; signs of kidney lesion), 20 with Stage III (GFR 60-30 ml/min/1.73 m2), and 11 with Stage IV (GFR 30-15 ml/min/1.73 m2). GFR was estimated using the Modification of Diet in Renal Disease (DMRD) formula. The authors made a questionnaire survey to identify day-to-day activity limitations and depressions and performed neuropsychological tests using the mini-mental state examination (MMSE), a frontal assessment battery (FAB) for frontal lobe dysfunction, a short-term and delayed memory test (Luria's 10 words test), and a regulatory function assessment test (RFAT). Magnetic resonance imaging (MRI) was carried out to clarify the etiology of CI. RESULTS: CI was detected more frequently in the patients with chronic renal failure (CRF) (Stages III-IV CKD) than in those without CRF (Stages I-II CKD) (in 90.3 and 35%, respectively (p < 0.001)). CI was statistically significantly more frequently found using MMSE (p < 0.001), FAB (p = 0.001), and RFAT (p < 0.001). There was a statistically significant rise in the magnitude of CI with the higher stage of CKD, as shown by MMSE, FAB, and RFAT, other than the short-term and delayed memory test. Brain MRI in the patients with CI revealed focal changes in 9 (30%) patients, leukoaraiosis in 7 (23.3%), lateral cerebral ventricular dilatation in 15 (50%), and markedly dilated hemispheric sulci in 3 (10%). CONCLUSION: The higher stage of CKD is associated with the increased incidence and magnitude of CI, as evidenced by MMSE, and with those of anterior brain dysfunctions. The comparisons of clinical and MRI findings suggest that cerebrovascular disorders underlie CI in CKD.