Yakymenko Y. Optimization of treatment of diabetic nephropathy combined with primary hypertension based on the changes of phosphorus-calcium metabolism and concentration of fibroblast grows factor 23.

The dissertation is devoted to the actual problem of modern medicine - to increase the effectiveness of treatment with nicotinic acid and low phosphate diet and to improve prediction of diabetic nephropathy (DN) combined with primary hypertension (PH). Features of phosphorus-calcium metabolism and concentration of fibroblast growth factor 23 (FGF23) in patient with DN in combination with PH were studied. Blood levels of FGF23 in patients with DN and PH correlate with phosphorus levels, renal function and left ventricle remodeling parameters (septum wall thickness, posterior wall thickness, left ventricle mass index). As a result of the work, in patients with DN with PH, a growth in the levels of FGF23 in the blood was found, as compared with practically healthy subjects, p<0.01, and patients with PH without DN, p<0.05. The highest levels of FGF-23 were found in the late stages of the disease, р<0,001. In patients with DN in combination with PH, a progressive increase in FGF-23 levels was found, depending on the stage of the disease associated with phosphorus levels, decreased GFR, urinary albumine, and LVM index. The highest concentrations of phosphorus and the lowest levels of calcium were found in the later stages of DN. The second part of the study was to evaluate the effectiveness of treatment with nicotinic acid and low phosphate diet. Combined therapy using nicotinic acid and low phosphate diet as well, as basic therapy contribute to a significant decrease in the serum FGF23 content in patient. The additional administration of nicotinic acid in contrast to basic therapy, led to significant decrease in phosphorus levels. In the group of patients, nicotinic acid was additionally obtained a more significant decrease in these indicators was found, the level of total cholesterol and triglycerides. New data were obtained, which allowed to optimize the therapy of patient with DN with PH. The practical significance of the results obtained is that patients with DN and PH are advised to determine the level of FGF23, phosphor and calcium. It is recommended for patients with DN and PH with hyperphospatemia -nicotinic acid.