Home – Home – Jornals – Siberian Scientific Medical Journal 2020 number 1

Recently, studies comparing various variants of operations to establish the optimal method of
surgical treatment for chronic pancreatitis with pancreatic head lesions from the point of view of evidence-based medicine have been carried out in the world. However, these comparative studies do not take into account differences in the clinical and morphological forms of the disease, in particular, chronic pancreatitis with a predominant and isolated lesion of the head. Subtotal resection of the pancreatic head with proximal pancreatojejunostomy, suitable for an isolated lesion of the head, does not solve all the problems of chronic pancreatitis with a predominant lesion of the head. In this case, the violation of the outflow of pancreatic juice along the pathologically changed main pancreatic duct from the left half of the gland is not eliminated. It is impossible to unambiguously support the hypothesis of the feasibility of performing subtotal resection of the pancreatic head with proximal pancreatojejunostomy in chronic pancreatitis with a predominant lesion of the head with a uniformly expanded main pancreatic duct. With this form of chronic pancreatitis, cicatricial strictures can form in the main pancreatic duct, which can lead to ductal hypertension and serve as an indication for reoperation. The feasibility of using Beger operation in chronic pancreatitis with a predominant lesion of the head is doubtful, since the intersection of the isthmus and the need for a T-shaped longitudinal pancreatojejunostomy makes this intervention technically difficult and unsafe. Based on the studies performed, it is impossible to say with certainty about the reliable advantages of one type of operations over another. To obtain reliable results, it’s necessary to conduct evidence-based studies comparing subtotal resection of the pancreatic head with longitudinal pancreatojejunostomy with other types of interventions only for chronic pancreatitis with a predominant head lesion, excluding from the study patients with chronic pancreatitis with isolated head lesion.

Cement in joint replacement remains the main treatment method for patients with injuries and diseases of major joints. It allows eliminating patient’s pain, correcting the axis and length of the limb, to restore the supportability of the limb and return the patient’s activity. At the same time, it is a very complex treatment method, which requires careful preparation and a rather long postoperative rehabilitation period. Cement prosthetics are most often used in elderly patients with osteoporosis, and, as a rule, with the presence of comorbidities that complicate surgical treatment, and occasionally prevent its implementation. The study of morphological changes occurring in organs and tissues is a necessary step in the study of pathogenesis. Thorough knowledge of these processes allows to develop pathogenetically based methods of prevention or to choose the most appropriate method of treatment. This determined the purpose of the study: on the basis of morphological, experimental data to study the features of somatic and cognitive complications that occur during cement endoprosthetics of the knee and hip joints. An experimental model (95 Wistar rats) of a femur fracture was used to study the effects of intramedural administration of methyl methacrylate. The results were studied after 1 hour, after 1, 3, 7, 30 days. Histological studies (preparations of the femur, brain tissue, heart, lungs, liver, kidneys) were carried out according to standard methods. The results indicate the combined nature of the effects on the body: there is mechanical damage, thermal effects and toxic effects of the methyl methacrylate monomer. The experiment showed that «bone cement implantation syndrome» is not limited only to impaired function of the cardiovascular and respiratory systems, as well as data on impaired renal function, liver, and signs of postoperative cognitive dysfunction.

The incidence of chronic
myeloid leukemia from 2004 to 2018 amounted to 0.63 per 100 000 people
per year. The prevalence of chronic myeloid leukemia over the past 15
years has increased from 1.88 to 7.02 case per 100 000 people. We have
analyzed the therapy outcomes of chronic myeloid leukemia of patients,
received imatinib treatment for more than 12 month (165 patients).
Complete hematologic response is attained in 88.5 % cases (146
patients), complete cytogenetic response (CCR) (ph+<0 %) - in 72.1 %
cases (119 patients), major molecular response (MMR) - in 50.3 % cases
(83 patients). The primary resistance to imatinib is observed in 21.8 %
cases (36 patients), secondary - in 6.1 % cases (10 patients - 7
patients have lost the complete hematologic response and CCR and 3
patients have lost the CCR and MMR). The thirteen patients of those, who
have primary or secondary resistance to imatinib have been treated with
second-generation tyrosine kinase inhibitors (nilotinib, dasatinib) and
in 93,3 % cases (14 patients) CCR have been obtained, 10 patients (66.7
%) have attained the CCR and 9 patients (60 %) have achieved MMR. Among
all those patients treated with I and II generations tyrosine kinase
inhibitors, we have carried out the overall survival (OS) analysis and
obtained following results: the median of OS have not been achieved,
5-year OS rate is estimated as 90 %, 10-year OS rate - more than 77 %,
calculated 15-year OS - more than 60 %.

Aim of the study was to
investigate the clinical features of reproductive age women with uterine
body myoma and the production of vascular endothelial growth factor
(VEGF) in the dominant myoma node and perifocal myometrium under the
preoperative use of ulipristal acetate (UA). Material and methods. 140
samples of 35 women surgical material were studied, VEGF content in the
incubation medium of samples of myoma and myometrium was measured using
enzyme-linked immunosorbent assay. Results and discussion. The treatment
by UA before myoma surgery according to the standard regimen per 5 mg
daily for 13 weeks deals with significantly reduced production of VEGF
in the dominant myoma node compared to perifocal myometrium ( p <
0.001), which is similar to patients of the control group. However, when
comparing tumor nodes, a significantly lower content of VEGF was
revealed in the UA-group ( p = 0.026); unlike the perifocal myometrium
samples. Conclusion. The use of a selective modulator of progesterone
receptors down-regulates the production of VEGF by the cells of the
myoma nodes and doesn’t impact on the perifocal myometrium.

The aim of the study is to
evaluate the effectiveness of endosialoscopy in the diagnosis and
treatment of patients with sialolithiasis. Material and methods. 106
clinical observations were analyzed in which computed tomography
(multislice spiral computed tomography or cone-beam computed tomography)
without contrast, salivary gland ultrasound and endosialoscopy were
used to diagnose and treat patients with sialolithiasis. In the process
of diagnostic sialoscopy, the patency of the ducts, the presence of
strictures and dilatations, the condition of their walls, the severity
of the vascular pattern, the integrity of the epithelial lining, the
contents of the ducts, the presence of mucus, pus, and, of course, the
presence of sialolites, their number, size, shape, density were
evaluated. Results and discussion. Endoscopy allows you to get unique
information about sialolite and the state of the ductal apparatus, which
determines the method of further treatment. Endosialoscopy can be used
as a standard diagnostic method for suspected sialolithiasis and for the
removal of sialolites (using endoscopic instruments) or as assistance.
At the same time, diagnostic endosialoscopy is not an exhaustive method;
therefore it should be carried out in conjunction with other methods -
computed tomography or ultrasound of the salivary glands. The
possibility of endoscopic sialolite removal depends on its mobility,
size, location and condition of the duct. Attempts to capture and remove
fixed sialolites, which are only partially visible and located in the
deep sections of the salivary gland beyond the bend or stenosis section
using endoscopic techniques, have been unsuccessful.

The aim of the study was to
compare the potential of fast pulse sequences and traditional static
images for evaluation of temporomandibular joint (TMJ) biomechanics and
to optimize the magnetic resonance imaging (MRI) protocol of TMJ by
inclusion of dynamic scanning to improve the diagnosis of internal
derangements. Material and methods. Dynamic MRI with HASTE and true-FISP
pulse sequences was integrated into conventional MRI examination of TMJ
in 16 symptomatic patients with pain, restricted motion and clicking in
the joint. MRI was performed on superconductive 1.5 T scanner Magnetom
Espree (Siemens, Germany). The presence of motion and susceptibility
artifacts, range of mandible head motion and intrarticular disc location
in different jaw positions were analyzed when comparing static and
dynamic series. Results and discussion. HASTE was chosen for dynamic
functional MRI of TMJ because it was less prone to susceptibility
artifacts and provided better tissue contrast compared to true-FISP. Our
initial experience has demonstrated dynamic scanning to be a
time-efficient supplementary technique providing detailed information
about TMJ biomechanics during active jaw movements at a high temporal
resolution compared to traditional MRI examination. However, minimal
anterior disc dislocation could be missed on dynamic series due to poor
visualization of the posterior disc band on full closing. The further
optimization of dynamic scanning technique on a large patients group
using principles of the evidence-based medicine is needed. This would
allow improving the diagnosis and assisting clinicians to optimize
treatment strategy in a wide range of TMJ disorders.

The purpose of the study is
the development of indications and evaluation of the long-term results
of surgical treatment of benign tumors and dysplastic processes of the
mandible by the method of replantation of resected bone exposed to
extraorganic freezing. Material and methods. A method for the surgical
treatment of benign tumors and dysplastic processes of the mandible has
been developed. It involves resection of an afflicted by pathological
process segment of bone within healthy tissues, its mechanical
processing, freezing in liquid nitrogen followed by slow thawing, and
replantation. The evaluation of the treatment results has been carried
out on the base of clinical, radiation and functional research methods.
Long-term follow-up after surgery has been ranged from one to 25 years.
Results and discussion. Positive results of surgical treatment were
recorded in 72 patients (88,9 %). The indications for the developed
method use have been established. It was found that the reconstruction
of the mandible with a resected bone segment exposed to extraorganic
cryosurgery, eliminates the recurrence of a benign tumor, provides for
the restoration of the anatomical integrity of the jaw, and reduces the
invasiveness of the operation. Conclusion. Long-term clinical experience
has shown that mandible direct reconstruction in the surgical treatment
of benign tumors and dysplastic processes with the method of resection,
external freezing of the afflicted jaw area and its replantation is
available, simple, and highly effective and can be recommended in the
practice of medical institutions.

The aim of the study was to
assess the possibility of using a surgical approach - anterior sagittal
anoproctoplasty in children who had previously been operated with
various techniques for anorectal malformations. Material and methods.
The analysis of postoperative results was performed using a scale for
assessing the long-term results of treatment of anorectal malformations
before and after surgery. A retrospective study of the patients who was
previously operated for various forms of anorectal malformations for the
period from 2016 to 2019 in pediatric surgery department of State
Novosibirsk district hospital was performed. The early and long-term
outcomes were assessed. Results. The criteria for repeated surgical
treatment were: rectal mislocated outside of the sphincter mechanism,
low social adaptation, secondary changes from the perineum and external
genital organs. After investigation (identification of the sphincter
mechanism using a myostimulator, irrigoscopy, MRI or MSCT of the pelvic
organs), all patients underwent surgical correction - the anterior
sagittal anoproctoplasty. Postoperative results were assessed using
Holschneider score. The results obtained in the course of this study
indicate the possibility of using this method of surgical treatment.
Discussion. Children previously underwent surgery for anorectal
malformations but having severe functional disorders in the anorectal
region, are a complex group of patients who must be determined specific
criteria for the reoperations need. The efficiency of surgical treatment
depends on the presence of associated congenital malformations
(myelodysplasia, pathology of the sacrum and tailbone), as well as the
severity of cicatricial changes in the sphincter mechanism. Surgical
intervention in 33.3 % of cases led to satisfactory and in 66.7 % of
cases to good results.

Background. Urethral
stricture is one of the most common complications after urethroplasty.
And nowadays a growing number of congenital urethral diseases is
observed. It is obvious that there is a huge amount of urethroplasty
needed all over the world. Material and Methods. 15 patients with
urethral strictures were included in the conducted prospective research.
All patients underwent a complex urology investigation consisted of
uroflowmetry, urethrography and urethroscopy. Most of strictures were
located in penile urethra, their length varied from 1 to 5 mm. All
patients enrolled in the study had the only single stricture. After
investigation internal visual urethrotomy was performed with one-time
stenting using individual prepared titanium nickelide stent. Stent was
in urethra for 14-21 days. It had been evacuated from urethra and
uroflowmetry, urethrography and urethroscopy were performed. Results and
discussion. All patients have good result of uroflowmetry in the
postoperative period. The results of urethrography and urethroscopy have
also showed that there were no urethral strictures. The longest
follow-up has lasted for 3 years. The efficiency of treatment is 93 %.
The repeated procedure was required in one case. Any complications of
this way of urethral stricture’s treatment haven’t occurred. Nowadays
laser urethrotomy is known to have a success rate about 84 %, but
follow-up period is still rather short. And also it is estimated that 65
% of all children with direct vision urethrotomy had a recurrence of
the stricture in 5 years. It is hoped that the announced way of
treatment of urethral stricture will be very perspective and will help
to solve such significant problem in pediatric urology as urethral
stricture. Conclusions. Stenting of urethra after internal visual
urethrotomy has good outcomes, and seems to be a very perspective
minimally invasive way of treatment of urethral stricture.

The aim of the study is to
assess the effect of systemic and local risk factors on the rate of
glaucoma progression, the specificity and informative nature of
ophthalmological studies for assessment of the rate of glaucoma
progression. Material and methods. A retrospective analysis of the
medical case histories and outpatient charts of 217 patients (268 eyes)
for the period from 2014 to 2017 was conducted. The patients with
primary open-angle glaucoma having at least 5 Humphrey field-of-view
(24-2) studies and optic coherence tomography of the optic nerve disk
and retina with a guided progression analysis (GPA) function (SD-OCT)
were included in the study. The patients were divided into 2 groups:
with rapid progression (more than 1 dB per year, 144 eyes (103
patients)) and slow progression (less than 1 dB per year, 124 eyes (114
patients)). The data of standard ophthalmological methods of
investigation (visometry, ophthalmoscopy, biomicroscopy, measurement of
intraocular pressure (IOP) according to Maklakov) were additionally
analyzed. Demographic and clinical data were assessed: gender, age,
cornea central thickness, refraction, IOP, glucocorticosteroid intake,
cardiovascular diseases presence, arterial hypertension, arterial
hypotension, local hypotensive therapy. Results and discussion. The
analysis revealed the main risk factors in glaucoma progression, which
include age, cardiovascular diseases presence, high initial IOP values,
pronounced functional changes in the visual fields (lower mean
deviation), pseudoexfoliation syndrome

Cavernous malformations
(CM), also known as cavernous angiomas or cavernomas, are benign
vascular hamartomas having a sinusoidal type of wall structure.CM occurs
in the brain stem with a frequency of 9-35 % of cases. They are most
often localized in the brain stem, have a higher risk of hemorrhage
compared to supratentorial. After the primary hemorrhage, the risks of
recurrent hemorrhages are very high. CM located in the brain stem has
not always been subjected to surgical treatment. Conservative treatment
was recommended for most patients. At the same time, according to the
literature data, mortality reached 20 %, and during radiosurgery up to
8.3 % with recurrence of hemorrhage up to 59 %. The aim of the study was
to evaluate the results of surgical treatment of patients with
cavernomas of the brain stem. Materials and methods. the study included
16 patients who had hemorrhages in different parts of the brain stem.
There were 12 males (75 %) and 4 females (25 %). Indications for
surgical treatment were: presence of subacute hematoma, recurrent
hemorrhage and progressive symptoms of brain stem damage. All patients
were operated using modern methods of microsurgery. Neurophysiological
monitoring was performed intraoperatively. Statistical processing was
carried out with the program Statistica (version 10). Results. There was
no operational mortality. At discharge, patients were assessed on the
Rankin scale. Good functional outcomes were achieved in 87.8 % of cases
(Rankin 1 - 43.8 %, Rankin 2 - 31.5 %, Rankin 3 - 12.5 %). Summary.
Symptomatic malformations of the brain stem are subject to surgical
removal when they are anatomically accessible. The use of modern methods
of neuroimaging, adequate, sparing surgical approaches, microsurgical
techniques for removing the cavernous brain stem, allows us to achieve
good functional results in the operated patients, in the absence of
postoperative mortality.

Objective of the study was to investigate clinical features of phenotypic variants of type 2 diabetes mellitus (T2DM) for personalization of hypoglycemic therapy. Material and methods. 2085 patients with T2DM (637 men and 1148 women), mean age 58.7 ± 6.9 years, duration of diabetes 7.8 ± 6.5 years; level of glycated hemoglobin (HbA1c), creatinine, urea, total cholesterol, triglycerides, low (LDL) and high density lipoprotein, uric acid, ALT, AST, insulin, C-peptide, microalbuminuria were examined. Depending on the level of C-peptide and the index of HOMA-IR, patients were divided into 3 groups: group of insulinopenic phenotype ( n = 250, 12 %), group of classical phenotype ( n = 1605, 77 %) and group of hyperinsulinemic phenotype ( n = 230, 11 %). Results. Patients with hyperinsulinemic phenotype differed from patients with classical and insulinopenic phenotype by later age of onset of diabetes (52.3 ± 8.1 years), high body mass index (BMI; 37.2 ± 7.4 kg/m²), blood LDL (3.38 ± 1.08 mmol/l) and creatinine level and frequency of chronic kidney disease (39.1 %). Patients with the insulinopenic phenotype had less diabetes duration (48.3 ± 7.9 years), a lower BMI (31.1 ± 6.3 kg/m²), higher blood glucose and HbA1c level and the frequency of diabetic polyneuropathy. Patients with the classic phenotype had a higher frequency coronary artery disease (20.8 %) compared to other phenotypes. Patients with insulinopenic phenotype on hypoglycemic tablets and patients with hyperinsulinemic phenotype on insulin therapy did not have HbA1c less than 7 %. Conclusions. To personalize therapy, the phenotypic variant of type 2 diabetes should be considered, with a study of the level of C-peptide, insulin and the calculation of the HOMA-IR insulin resistance index to determine the phenotype.

The purpose of the study was to assess the level of quality of life in the postoperative period in patients with bullous emphysema of the lungs operated on by «open» access and using minimally invasive technologies using the SF-36 questionnaire. Material and methods. The results of a survey of 50 patients with bullous emphysema were analyzed. The patients were separated into 2 groups depending on the method of access. The first group (main) consisted of the patients underwent video-assisted thoracoscopy, resection of a bulla-modified lung tissue, subtotal parietal pleurectomy. The second group (comparison) consisted of the patients underwent thoracotomy, resection of a bulla-modified lung tissue, subtotal parietal pleurectomy. The survey was conducted using the SF-36 quality of life questionnaire for 1, 3, 6 and 12 months. Results and discussion. The main indicators of the quality of life of respondents in terms of 1, 3 and 6 months after the intervention were statistically significantly higher in the group of patients who underwent thoracoscopy. Only a year after the operation, the main indicators of the questionnaire were not statistically significantly different between groups of patients, but the indicators of vital activity, social functioning, mental health and psychological component of health remained significantly higher in patients of group 1. The results indicate the need for long-term postoperative rehabilitation of patients with bullous emphysema lungs, operated in an «open» way. Follow-up survey with the specific questionnaires is required for more detailed assessment of the level of quality of life in patients with thoracic organs pathology.

The practical significance
of heparin low-molecular fractions as inhibitors of inflammation and
antithrombin III consumption reduction were studied. That is most
critical in acute hepatic failure. The study was performed using the
low-molecular-weight heparin (Nadroparin calcium) in low (prophylactic)
doses of 2000 anti-factor Xa units daily per 1 meter squared in the form
of continuous intravenous infusion. The cohort study proved the
nadroparin positive effect on carbohydrate and protein metabolism in
children with acute poisoning by hepatotoxic poisons, The significant
decrease in the quantitative assessment of disseminated intravascular
coagulation relative to the comparison group has been revealed, and the
decrease in 28-day mortality from 42 to 13 % has been found in children
receiving nadroparin. Conclusions are drawn on the feasibility of
introducing low molecular weight heparins into the intensive care
regimen of liver failure.

The aim of the study was to
investigate the nutritive status and identify risk factors for
cardiovascular disease in patients on hemodialysis. Material and
methods. 144 patients on program hemodialysis were examined. All
patients underwent general clinical and laboratory examination, lipid
profile was examined, body mass index was calculated, waist and hip
circumference was measured, ratio of waist circumference to the
circumference of hip was determined, abdominal integral multi-frequency
bioimpedansometry and multispiral computed tomography were performed.
Results. Gender features of distribution of abdominal adipose tissue and
dyslipidemia in patients on program hemodialysis were revealed. Women
have a predominant accumulation of visceral adipose tissue, while men
are characterized by a proportional distribution of subcutaneous and
visceral adipose tissue in the abdominal area. Women compared to men
have higher rates of atherogenic lipoprotein fractions, which level is
closely related to the volume of visceral adipose tissue. Among the
comorbidities in the examined patients, diseases of the cardiovascular
system predominate. The regression analysis revealed that the most
significant risk factor for the development of coronary artery disease
is an increase in low-density lipoproteins, for chronic heart failure -
an increase in waist circumference. Conclusions. The data obtained
indicate the need to monitor the nutritional status of patients on
hemodialysis to identify and correct risk factors for cardiovascular
disease.

The purpose of the study
was to investigate the main factors predisposing to the birth of
children at gestational age of 34-36 weeks, the features of the course
of the neonatal period, the structure of morbidity and mortality in the
conditions of the regional perinatal center. Material and methods. A
retrospective analysis of 380 medical records of an inpatient patient of
the Regional Perinatal Center of State Novosibirsk Regional Clinical
Hospital born on a gestational age of 34-36 weeks for 2017-2018 was
performed. Results and discussion. All women with premature late
delivery had a burdened somatic and/or obstetric-gynecological history.
70 % of women were delivered by surgery. The anthropometric
characteristics of late preterm infants in 85 % of cases corresponded to
gestational age, in most of them the neonatal period proceeded with the
development of respiratory disorders, hyperbilirubinemia, and low
tolerance to enteral nutrition. Children with less gestational age
needed respiratory support for a longer time. Due to the difficult
condition at birth, about 40 % of the children were transferred from the
maternity ward to the intensive care unit of the newborn. A quarter of
late premature infants received medical care exclusively in a maternity
hospital. The mortality rate was 1 %. Thus, late premature babies are a
special category of newborns, when nursing which it is necessary to
carry out timely diagnosis of pathological conditions, as well as the
prevention of adaptation disorders, especially in the early neonatal
period.

The aim of the research was to study the effect of genetic predictors of thrombotic/ischemic events in children with the developed complications and born mature or premature. Material and methods. A prospective follow-up monitoring of 47 patients (inpatients of the State Novosibirsk Regional Clinical Hospital) with thrombotic complications, the analysis of their medical records were carried out. The homeostasis system parameters, carriage of polymorphic variants of genes predisposing to thrombotic complications were accomplished for the children during the follow-up period. Results and discussion. Thrombotic and/or related ischemic events are more common in premature infants, herewith the severe cerebral ischemia and venous thrombosis localized in various vessels predominated over these complications. The state of the blood coagulation system in children with thrombotic/ischemic events is characterized by hypercoagulation shifts in the external and internal cascades of blood coagulation and accompanied by the increase in the D-dimers level. Among polymorphic variants of genes of hemostasis system the occurrence of polymorphic variant FV Leiden (rs6025) is higher in the study group compared to the European population (χ² = 7.454; p = 0.025). The obtained data indicate the need for extended diagnostic studies of hemostasis system and genetic search for «thrombogenic» predisposition in children, especially premature, residing in intensive care units for the presence of thrombotic readiness in order to timely predict the development of possible thrombotic and ischemic complications.

The aim of the research is
to study nosological structure, features of kidney, lung damage, deaths
in patients with ANCA - associated vasculitis underwent medical
treatment in a multidisciplinary hospital. Material and methods.
Selection and subsequent retrospective analysis of the medical histories
of 38 inpatient patients observed in nephrological, rheumatological,
pulmonological and surgical thoracic departments for the period from
January 2012 to December 2018 were carried out. The disease main
clinical symptoms, variants of the X-ray picture, and causes of death
were assessed in the patients according to the clinical and laboratory
examination. Results and discussion. The most common diagnosis was
eosinophilic granulomatosis with polyangiitis (EGPA) - 16 cases;
microscopic polyangiitis was diagnosed in 11 patients, granulomatosis
with polyangiitis - in 9 persons. In 2 cases, ANCA-associated vasculitis
was diagnosed without specifying the nosological form. The most common
symptoms in patients with ANCA-vasculitis were fever, progressive
shortness of breath, weakness, artalgia, eosinophilia, which occurred
mainly in patients with EGPA. Among analyzed 38 cases, there were 6 men
and 32 women. The average age of patients was 50.72 ± 12.6 years. There
were 5 deaths and, in 2 cases, the outcome could not be clarified. All
deaths occurred during the first year from the disease onset caused by
infectious complications or severe manifestations of the main disease.

The purpose of the study
was to present the stages of effective nephrological service forming and
to evaluate the output results of the Regional Nephrological Center
(RNC) as the unit of multidisciplinary hospital. Results and discussion.
The nephrology service of State Novosibirsk Regional Clinical Hospital
began to form in 1978 with the opening of nephrology hemodialysis and
kidney transplantation departments. The RNC was established in 1993 on
the base of a territorial register for patients with chronic renal
failure. Currently, the RNC includes the department of nephrology, the
register for patients with chronic kidney disease (CKD) of 3-5 stages,
nephrological counseling office, offices for potential recipients of
renal transplantation and for patients with transplanted kidney, the
office of permanent outpatient peritoneal dialysis. As a result, the
prevalence and structure of CKD 3-5 stages in the Novosibirsk region are
comparable to those in Europe, the availability of the renal
replacement therapy, including the number of patients with a functioning
renal transplant exceeds the nationwide indicators. Conclusion. The
model of the nephrological service of a multidisciplinary hospital
provides accounting and dispensation of patients with CKD, increases the
effectiveness of treatment, including methods of renal replacement
therapy.