Of all cases of acute kidney injury (AKI), 45-70% are associated with sepsis. Lethality in sepsis-associated AKI requiring renal replacement therapy (RRT) ranges from 40 to 50%, and in AKI combined with other organ dysfunctions - 60-80%. In order to improve the results of treatment of sepsis and septic shock, various methods of extracorporeal detoxification (ECD) have been developed. The effectiveness of these methods is controversial. In the treatment of sepsis, RRT is used not only to replace the impaired detoxification function of kidneys, but also to remove excess cytokines from the systemic bloodstream. The literature describes mainly positive results of the use of dialyzers with an adsorbing membrane, however, these data do not have the necessary degree of evidence. Currently, there are no clear criteria for the initiation of RRT, its duration and doses, the choice of methodology determined by specific clinical and laboratory parameters, and staging of this therapy. All this highlights the need for further research in this field.

Introduction. The prevalence of rhabdomyolysis among people admitted to the hospital due to acute poisoning reaches, according to various foreign sources, from 30 to 40%. In 60% of cases, the development of rhabdomyolysis in adult patients is associated with acute exogenous intoxication. Currently, data on the prevalence, structure and outcomes of treatment of rhabdomyolysis in toxicological patients are mainly presented by the results of foreign clinical and epidemiological studies. The aim is to study the prevalence, structure, frequency of complications and outcomes of treatment of rhabdomyolysis in acute exogenous intoxication in a multidisciplinary hospital. Material and methods. The study included 1,363 patients who were treated from 2017 to 2020 with acute exogenous intoxication. During the study, 98 patients with rhabdomyolysis were selected from the general group. The frequency of poisoning with various toxicants was analyzed, the effects of which led to the development of rhabdomyolysis in acute exogenous intoxication. The incidence of acute kidney injury (AKI) was detected, the outcomes of acute poisoning treatment, the duration of inpatient treatment were determined, and a comparative analysis was carried out between groups of patients with rhabdomyolysis in acute exogenous intoxication (n=98) and without it (n=1265). Results. The prevalence of rhabdomyolysis among patients hospitalized for acute poisoning was 7%. The main reason for the development of rhabdomyolysis was the use of narcotic drugs - 87% of cases. The development of rhabdomyolysis in acute exogenous intoxication in 59.2% of cases is accompanied by the occurrence of AKI, which is significantly higher than among patients without rhabdomyolysis (11.6%). The occurrence of rhabdomyolysis in toxicological patients increases hospital mortality from 6.1 to 10.2%, as well as the duration of inpatient treatment and intensive care by 5.2 and 3.3 days, respectively. Limitations. The study was conducted based on only one multidisciplinary hospital in Moscow in the period from 2017 to 2020. Conclusion. Rhabdomyolysis is a serious complication of acute poisoning, the development of which significantly worsens the outcomes of treatment of patients with a toxicological profile, which requires the development of effective methods for the prevention, diagnosis and treatment of rhabdomyolysis in acute exogenous intoxication.

The course of the COVID-19 pandemic has led to a critical increase in the burden on virtually all major branches of the health care system in our country and abroad.   The aim of this article is to analyse the activities of the different parts of the city nephrol­ogy service in Saint-Petersburg and to consider promising ways to improve it.   The nephrology service for the adult population in St. Petersburg includes: outpatient service; inpatient service - 183 beds in 24-hour inpatient departments of the city; dialysis service - 10 dialysis units in municipal medical organizations, 5 in federal institutions, and 8 centers/departments operating in the framework of private-public partnership. The number of patients on dialysis programme decreased by 10.5 % to 1,839 in 2021. These changes are likely due to an increase in mortality among these patients in 2020 and 2021 which is a consequence not only of COVID-19 but also of the adverse impact of the pandemic on the health system. The proportion of patients treated as outpatients in private dialysis centres increased during the three-year period. The incidence of arteriovenous fistula formation in primary vascular access decreased from 33.2 % to 14.2 % in 2020 compared with 2019. At the same time, the use of temporary central venous catheters as primary vascular access for renal replacement therapy has increased significantly from 43.0 % to 61.9 %. The development of the nephrology service is largely determined by its funding. To compensate the costs of medical in­ stitutions in the city for conducting renal replacement therapy it is necessary to increase the tariffs of compulsory health insurance (CHI) by at least 50 %. In the medical organizations of Saint-Petersburg municipal and federal subordination the share of "artificial kidney" devices that have used up their resource is 32.2 %, and in a number of medical institutions it exceeds 50 %.

The objective: to study in vitro adsorption properties of various devices for selective lipopolysaccharide (LPS) adsorption.Subjects and Methods: Various methods of closed circuit circulating bovine serum endotoxin solutions were used. The serum was perfused using an LPS sorption device for 240 min. Serum samples were collected before the start of perfusion, and 30, 60, 120, 150, and 240 minutes after the start of circulation. LPS concentrations were measured by the turbidimetric method. One column for polymyxin hemoperfusion and three devices for selective adsorption of lipopolysaccharides were assessed.Results: When using the device for polymyxin hemoperfusion, the concentration of endotoxin in bovine serum decreased by 61% during 120 minutes, and in 120 minutes after additional administration of endotoxin, it went down by 57%. When using the other three devices, these parameters made 9% and 6%, 10% and 8%, 5% and 10%, respectively. Conclusion. By definition, an in vitro study cannot provide for complex pathophysiological reactions occurring in the body during sepsis. Тhis fact leads to limitations in extrapolating the results obtained to clinical practice.

No abstract