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System inflammation and protein energy wasting correction in patients with chronic kidney disease

M. I. Chaikovska, L. P. Martynyuk
Ukrainian Journal of Nephrology and Dialysis pp 41-47; doi:10.31450/ukrjnd.2(62).2019.06

Abstract: Protein-energy wasting as a manifestation of nutritional disorders is one of the central complications in chronic kidney disease (CKD) and largely determines quality and life expectancy. Both decrease in nutritional status and systemic inflammation are independent predictors of general and cardiovascular mortality. Mutual stimulation of these factors determines the search for new directions for the treatment of patients with CKD. The aim of the research was to study the state of systemic inflammation and malnutrition in CKD by assessing the level of interleukin 1β (IL-1β), interleukin 6 (IL-6), interleukin 8 (IL-8) and C-reactive protein (CRP) and serum albumin and to study the effectiveness of therapy with levocarnitine and a solution of a mixture of ketanalogs of irreplaceable and substitute amino acids for parenteral administration in CKD. Results. The level of markers of inflammation IL-1β, IL-6, IL-8 and CRP progressively increased in parallel with the development of renal failure. The level of albuminemia decreased from the I to the V stage of the CKD, in which among patients with glomerular filtration rate 15 - 45 ml/(min · 1.17 m2) in 14% there was a malnutrition of a mild degree; whereas, at CKD of the V stage, malnutrition of a mild degree was in 16% of patients, moderate malnutrition was detected in 10% of the subjects, and 5% suffered from severe malnutrition. After standard therapy the least effect was observed. A more significant decrease in the level of proinflammatory cytokines and CRP was observed with the additional acquisition of levocarnitine. An even better effect was observed in the group of patients receiving Nefrotect. The most significant level of inflammation markers decrease was seen in the group receiving combined Nephrotect therapy with levocarnitine Nefrotect, where the concentration of proinflammatory interleukins decreased more than threefold compared with baseline. The level of albuminemia reached the highest level with combined therapy, compared with standard therapy. Conclusions. Nutritional status of patients with CKD decreases progressively in the fall of kidney function, reaching the level of mild malnutrition at CKD stage III and the severe degree of malnutrition at CKD stage V. With the progression of renal failure, activation of the systemic inflammation, in particular, the increase of the level of circulating in the blood of interleukin 1β, interleukin 6, interleukin 8 and CRP was seen. The efficacy of treatment of systemic inflammation and protein-energy insufficiency by levocarnitine and a solution of a mixture of ketonalogs ofirreplaceable and substitute aminoacids in the cohort of patients with CKD of the І-V stages is proved. This combined therapy significantly lowered the level of interleukin 1β, interleukin 6, interleukin 8, and CRP, as well as elevated serum albumin levels in patients with CKD.
Keywords: Treatment / chronic kidney disease / renal failure / systemic inflammation / Quality and Life / Protein Energy / inflammation and protein

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