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Статья посвящена важной проблеме детской реаниматологии и нефрологии - типичному гемолитико уремическому синдрому (тГУС). Проведено ретроспективное исследование 267 больных с тГУС за последние 5 лет. Проведена оценка клинико лабораторных данных больных и результатов лечения. Летальность составила 2,27%. Выявлено, что заместительная почечная терапия потребовалась 74,5% пациентам, основным методом заместительной почечной терапии (55,3%) был перитонеальный диализ. Анурия в дебюте заболевания являлась неблагоприятным фактором, ассоциированным с повышенным риском полиорганного поражения, вовлечения центральной нервной системы, летального исхода, а также длительной заместительной почечной терапии и неполного восстановления функций почек. С анурией ассоциирован более высокий уровень маркеров воспаления, гемолиза, тромбообразования и более низкий уровень компонента комплемента С3, а также большая длительность тромбоцитопении, что позволяет рассматривать эти показатели как предикторы тяжести тГУС. Развитие острого повреждения почек с анурией у больных с тГУС по большинству показателей значительно ухудшает прогноз пациентов и является фактором неблагоприятного прогноза у больных с тГУС.

Chronic kidney disease (CKD) is currently one of the most common diseases among chronic noncommunicable diseases. The progression of chronic kidney disease leads to the end-stage of the disease, which, in turn, is called end-stage renal failure and is characterized by a sharp decrease in the quality of life of patients, contributes to disability and disability, and also leads to the need to use expensive methods of renal replacement therapy: peritoneal dialysis, hemodialysis, kidney transplantation.

Goal: to conduct pharmacoeconomic analysis of using the darbepoetin alfa (Aranesp) and other erythropoiesis-stimulating agents for anemia correction in patients on hemodialysis or peritoneal dialysis. Methodology. The study included both original medications: darbepoetin alfa (Aranesp), epoetin alfa (Eprex), methoxy polyethylene glycol-epoetin beta (Mircera), and bioanalog - epoetin alfa (Eralfon). Due to the fact that data are available regarding the discrepancy between the actual dosage of darbepoetin and instructions for drug use (meta Bonafont et al.), to assess the actual practice in a national health system was conduct a retrospective observational study in 11 hospitals of different regions of Russia. Budget Impact Analysis (BIA) was used as the most informative method to identify sources to optimize budget spending allocated for drug coverage this category of patients - only direct medical cost took into account such as cost of the drugs, intravenous administration, the transfusion and the cost of unplanned hospitalization for cardiovascular reasons or due to infection. The same calculation was made changes total cost (savings budget) at a magnification of hospital purchases Aranesp share 15% (± 5% of each of the compared drugs) depending on the target value of the level of hemoglobin. One-way sensitivity analysis of the model to the price of Aranesp ± 10% and reduce the dose of Aranesp by 20% and 47% (based on expert data), as well as to changes in the cost of hospitalization was spend. Results. Data on the efficacy and safety of different types of anemia correction in patients on hemodialysis or peritoneal dialysis have been analyzed. In the literature review was concluded on a similar efficacy and safety of drugs included in the study. Cost analysis showed darbepoetin economic advantage for all the analyzed indicators (total costs per patient attained control, the total annual costs). Sensitivity analysis showed that the results are most sensitive to a change in dose and price of darbepoetin. Despite the fact that these actual practices indicate a possible reduction in the dose of Aranesp by 47%, the economic benefit of the drug Aranesp maintained even at reduction by 30%. Conclusions. Using Aranesp in dosages used in actual practice for correction of anemia in patients undergoing hemodialysis or peritoneal dialysis is more cost-effective way of treatment compared with other alternative erythropoiesis-stimulating drugs.