Litovkina Z. Clinical and Pathogenetic Features of Heart Remodeling and Its Correction in Patients with Diabetic Nephropathy Treated with Hemodialysis

The thesis is devoted to increasing the efficiency of treatment and diagnosis of patients with diabetic nephropathy receiving hemodialysis by studying the clinical and pathogenetic features of heart remodeling and its changes under the influence of complex pathogenetic treatment with the inclusion of magnesium aspartate and L-carnitine. Based on a comprehensive study, the pathogenetic patterns of maladaptive heart remodeling in patients with type 2 diabetes mellitus treated with hemodialysis were established for the first time, on the basis of which effective programs to reduce cardiovascular risk have been developed. Synergism and interdependence of chronic inflammation and endothelial damage/ dysfunction in patients with diabetic nephropathy, their pathogenetic relationship with cardiohemodynamic disorders have been demonstrated for the first time; the integrating role of magnesium deficiency in the implementation of the mechanisms of complex structural and functional reorganization of the heart and the progression of atherosclerosis has been shown. It has been specified that cardiac remodeling in patients with type 2 diabetes mellitus receiving hemodialysis is determined by the formation of unfavorable (eccentric and concentric) types of left ventricular hypertrophy, right ventricular dilatation, pulmonary hypertension, severe diastolic and systolic dysfunction. It has been determined for the first time that diabetic nephropathy is characterized by widespread combined calcification of the mitral and aortic valves, which, in turn, leads to the formation of heart defects, contributes to the progression of myocardial diastolic stiffness and the development of heart failure. Progression of heart valve calcification has been shown to be closely associated with the severity of atherosclerotic lesions. The study of lipid and phosphorus-calcium metabolism with further study of the features of secondary hyperparathyroidism in patients with diabetic nephropathy has been further developed; the pathogenetic relationship between magnesium deficiency and triacylglycerol accumulation and cholesterol lowering of high-density lipoproteins has been identified. The study examined the effectiveness of inclusion of magnesium aspartate and L-carnitine in complex therapy as a new pathogenetic strategy of drug treatment in hemodialysis patients with diabetes to improve myocardial remodeling processes, prevent progression of calcification of heart valve depressions, reduce the activity of systemic manifestations of inflammation, endothelial destruction, optimization of nitric oxide metabolism, lipid and carbohydrate metabolism, reducing the incidence of cardiovascular complications and increasing patient survival.