Kravtsova V. Features of the course of chronic heart failure in patients with chronic kidney disease under the influence of therapy with blockers of the renin-angiotensin-aldosterone system. - Qualifying scientific work on the rights of manuscript.

The study is devoted to the problem of activation of the renin-angiotensin-aldosterone system and the effect on the structural and functional state of the heart, blood vessels and kidneys in patients with CHF and CKD. Effects of RAAS blockers, taking into account the level of the left ventricular ejection fraction of the heart and the development of the algorithm of individualization therapy. Study is based on the analysis of data obtained during the examination and treatment of 129 patients (109 patients with CHF and CKD, 20 patients with CHF) (44 men and 85 women) aged 45 to 65 years. The features of the clinical course and their relationship with RAAS activity indices in patients with CHF without concomitant pathology and in combination with CKD and on this basis to determine the contribution of CKD to the formation of features of the course of CHF in comorbid pathology were studied. In patients with CHF in combination with CKD, the features of cardiac, vascular and renal structural and functional state, the activity of the RAAS components, their interrelations and assess the effect of CKD on structural and functional state of the target organs and neurohumoral status were established. Specific features of activation of RAAS and parameters of cardiac, vascular and renal structural and functional state in patients with CHF on the background of CKD, depending on the ejection fraction of the left ventricle. A comparative assessment of the effect of RAAS blockade on the clinical course, of cardiac, vascular and renal structural and functional state in patients with CHF with a preserved and "mid-range" EF in combination with CKD was carried out. The estimation of the effect of antagonist of mineralocorticoid receptors on the clinical course, neurohumoral status and of cardiac, vascular and renal structural and functional state in patients with CHF with reduced EF in combination with CKD was studied. Based on the analysis of the effect of RAAS blockade at different levels, methods for optimizing the treatment of patients with CHF with a preserved and "mid-range" EF in combination with CKD were developed.