Ryndina N. Pathogenetic and therapeutic, prognostic aspects of the development and progression of anemia in chronic heart failure in patients with ischemic heart disease combined with chronic kidney disease.

The thesis is devoted to improve the efficiency of diagnosis and treatment of anemia in patients with chronic heart failure due to ischemic heart disease depending on the presence or absence of chronic kidney disease based on the elucidation of character of erythropoiesis mechanisms and definition of standard therapy efficacy predictors involving iron (II), (III) drugs, or its combination with erythropoietin stimulating agents. Parameters of iron metabolism and kidney function, markers of immune inflammation, parameters of cardiohemodynamics, nutritional status and quality of life, efficiency of iron (II), (III) drugs or its combination with epoetyn ? as a part of standard therapy, predictor informativeness of clinical and anamnestic parameters, cardiohemodynamics, indicators of iron metabolism and kidney function on the effectiveness of antianemic therapy were investigated. The obtained results indicate that increasing of renal dysfunction is accompanied by high activity of proinflammatory interleukin-6, reduction of antiinflammatory interleukin-10, increasing of central regulator of ferrokynesis hepcidin, a violation of the transport iron fund, iron deficiency with high levels of deposited iron fund, violation of nutritional status by visceral proteins, decreased erythropoietin synthesis and consequently decreased erythropoietic activity of bone marrow, anemia formation with hypochromic and microcytic elements in patients with chronic heart failure due to ischemic heart disease and chronic kidney disease, and in patients without chronic kidney disease - the formation of anemia due to iron deficiency as a result of cytokine mediated high hepcidin activity with ineffective erythropoiesis in conditions of erythropoietin resistance. The possibility of anemia therapeutic correction individualization using iron (II), (III) drugs or its combination with epoetyn ? as part of the standard therapy by identifying clinical and anamnestic, cardiohemodynamic, ferrokinetyc predictors.