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Background. Secondary hyperparathyroidism (sHPT) is one of the serious complications in chronic kidney disease and is associated with progressive bone disease and vascular calcification. The objective of the study was to determine the impact of Mimpara (Cinacalcet HCl) on mineral disorder, bone turnover and bone mineral density (BMD) versus parathyroidectomy (PTx) in haemodialysis patients' refractory to alfacalcidol. Materials and methods. 62 haemodialysis patients with sHPT were enrolled in this 6 months prospective study. All of them had surgical indications for PTx. Surgical indications was established according to clinical or biological assessment. 40 patients underwent Mimpara treatment. Dose of Mimpara was titrated every 4 weeks. Sequential doses included 30-180 (mean 59.1 ± 34.2) mg/day. 22 patients underwent PTx. The sur gical technique was depended on quantity of hyperplastic parathyroid glands. Results. In 6 months mean iPTH, Ca, Са×Р, CTx and OC levels significantly decreased by 55.7%, 13.8%, 34.3%, 21.4 and 1.4% in the Mimpara group vs. 90.7%, 14%, 55.5%, 58.7% and 26.9% in the PTx group. Median serum iPTH level decreased by 30% after initiation of Mimpara in 94.3% patients, from them by 50% in 74.3%. Achieved the KDOQI treatment targets for PTH in 28.6% patients.In 6 months after PTx median serum iPTH level was <100 pg/ml in 50% patients, achieved the KDOQI treat ment targets in 27.3%, >300 pg/ml in 18.2%. Median serum 25(ОН)D after PTx significantly increase by 127.3% vs 6.72% in the Mimpara group. In 6 months active restoration of BMD was found in the PTx patients, and patients treated with Cinacalcet showed stabilization of BMD. Mimpara therapy led to a reduction in glandular volume during the course of the study: in both glands with a baseline volume <500 mm 3 and with a baseline volume ≥500 mm 3 . Conclusions. PTx and Cinacalcet therapy improves phosphorus calcium homeostasis, bone turnover, but bone resorption and formation markers decreased better in the PTx group compared to Cinacalcet group. The effectiveness and safety of Mimpara for secondary hyperparathyroidism were evaluated in dialysis patients' refractory to alfacalcidol, which reduced the need for parathyroidectomy in patient without severe osteodystrophy.

Ключевые слова: синдром раздраженного кишечника, серотонин, транспортер обратного захвата серотонина, полиморфизм, генотип, аллели, SERT, 5-HTTLPR, SLC6A4 Для цитирования: Пушкина АВ, Авалуева ЕБ, Бакулин ИГ, Топанова АА, Мурзина АА, Ситкин СИ, Лапинский ИВ, Сказываева ЕВ. Функциональный полиморфизм транспортера обратного захвата серотонина гена SLC6A4 при различных клинических вариантах синдрома раздраженного кишечника.

Background and Aims The percentage of patients receiving RRT for ESRD secondary to diabetes mellitus (DM) is equal to 20-30% nowadays and is trending upward. Unfavourable changes in nutrition and body composition is highly prevalent in patients with chronic kidney disease (CKD) undergoing dialysis. DM type 2 (DM2) coupled with CKD is an additional factor for nutrition abnormalities in dialysis patients due to more prominent inflammatory status and insulin resistance. Resting energy expenditure is significantly higher in hemodialysis patients with DM2 than in those without it. Daily energy intake as usual is substantially less than required in the most dialysis patient, suggesting that patients could develop protein-calorie wasting and sarcopenia. The aims of our study were to compare of nutritional status in hemodialysis patients with and without DM2 and to treat revealed nutritional abnormalities by correction of the protein and energy intake. Method 79 hemodialysis patients (aged 50 to 70 years) were divided in two groups: 40 with DM2 and 39 without DM2. The groups didn’t distinguish by age, gender, comorbidity, dialysis duration and adequacy. In the DM2 group there were no patients with severe diabetes complications or decompensation. All patients kept a 3-days food diary for assessment of protein and other nutrients and energy intake. The examination, which included anthropometry, measurement of body composition by bioimpedance analysis, biochemical parameters (serum albumin, transthyretin, C-reactive protein (CRP), interleukins 1 and 6 (IL1 and IL6), advanced glycation endproducts (AGE)), was performed at baseline, and then after 6 and 12 weeks of the dietary treatment. The pattern of the diet for every patient was based on the individual parameters of nutrient and energy intake obtained from the food diary. The aim of the diet was to make good the deficit of protein and energy intake. Results Baseline BMI and degree of abdominal obesity were significantly higher in DM2 group, but lean mass (LM), hand grip strength and gait velocity were significantly less. The significantly more decreased level of transthyretin was identified in DM2 group. Levels of AGE and CRP were not different between the groups, but were twice higher of normal range. IL6 was significantly higher in DM2 group. Protein and energy intake were under dietary recommendations for dialysis patients in DM2 group. We identified positive association between protein intake and levels of albumin and transthyretin and negative with IL1, IL6 and AGE in patients with DM2. In patients without DM2 we revealed negative correlation between LM and CRP. The dynamic of the main anthropometric and biochemical parameters are represented in the table. Conclusion A degree of persistent inflammation and sarcopenia more prominent in hemodialysis patients with DM2. Absence of appetite due to inflammation is a probable cause of low protein and energy intake in those patients. Balanced diet based on individual nutritional requirements can effectively improve nutritional status of the dialysis patients with DM2 and decrease inflammation.