Ludmila Milovanova

By L. Milovanova, Y. Milovanov and A. Plotnikova

Part of the book: Chronic Kidney Disease and Renal Transplantation

By Ludmila Y. Milovanova, Victor V. Fomin, Lidia V. Lysenko (Kozlovskaya), Nikolay A. Mukhin, Svetlana Y. Milovanova, Marina V. Taranova, Yuriy S. Milovanov, Vasiliy V. Kozlov and Aigul Zh. Usubalieva

The chapter discusses the current understanding of the system of mineral and bone metabolism regulators—FGF-23, Klotho and sclerostin—disturbances in chronic kidney disease (CKD). In the chapter we presented the date, including our own results, which allow to suggest the change in the ratio of FGF-23-Klotho-sclerostin in CKD as an early biomarker not only for the chronic kidney damage but also for high cardiovascular (CV) risk. Results of studies show that disorders in FGF-23-Klotho-sclerostin ratio correlate with the frequency and severity of hypertension, vascular calcification, cardiac remodelling, anaemia, malnutrition, inflammation and strong aggravate CV risk in CKD. It was found independent from blood pressure (BP) action of increased serum FGF-23 on the myocardium as well as the correlation of serum high-sensitive troponin I with increased serum FGF-23 and low Klotho levels in CKD patients. At the same time, it was shown that renoprotective therapy, including renin-angiotensin blockers, low-protein diet with amino/keto acid supplementation and phosphate binders, erythropoiesis stimulators, vitamin D metabolites used to get the target levels of BP, serum phosphorus, haemoglobin, parathyroid hormone and nutritional status disorders correction can reduce the risk of CV events, as the major cause of death in CKD patients.

Part of the book: Chronic Kidney Disease

By Ludmila Y. Milovanova, Victor V. Fomin, Lidia V. Lysenko (Kozlovskaya), Yuriy S. Milovanov, Nikolay A. Mukhin, Vasiliy V. Kozlov, Marina V. Taranova, Svetlana Y. Milovanova, Marina V. Lebedeva and Aigul Zh. Usubalieva

Despite the significant achievements in the management of chronic kidney disease (CKD) patients, the mortality rate of these patients still remains high. Nutritional status disorders (NSD) are considered now as one of the prognostic risk factors not only for dialysis but also for predialysis CKD stages. Since the publication of KDIGO 2012 guidelines for CKD patient’s management, there has been some significant advancement in our understanding of main NSD mechanisms in CKD, including different nosological group patients (first, in diabetic and systemic diseases patients). At the same time, there is still an urgent need for randomized trials for better-informed decisions and future optimization of CKD patients’ care. This chapter provides the current data on all aspects of NSD in CKD: etiology, diagnosis, prevention, and treatment approaches, as well as on risk factors of NSD at predialysis stages and in chronic hemodialysis patients. Considerable attention was devoted to the diagnosis and differential diagnosis of NSD in CKD patients. It was determined that the overall strategy for dietary treatment contributed to improving the life quality of patients and slowing down of CKD progression. The review is written based on the published results of clinical studies performed on the position of evidence-based medicine.

Part of the book: Chronic Kidney Disease