Evaluation of the index of resistance and excretion of uromodulin in patients with predialysis chronic kidney disease, taking into account the index of comorbidity

L.D. Denova, D. Ivanov
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Thirty (32.97 %) men and 61 (67.03 %) women were divided into two groups, which were representative in terms of age and gender composition: the first one (n = 46) — patients with CKD stage1–5 who had Charlson Comorbidity Index ≤ 2, the second one (n = 45) — patients with CKD stage1–5 who had Charlson Comorbidity Index ≥ 3. The first and second groups were divided into subgroups A and B. Subgroup A included patients with impaired vegetative status, subgroup B — without impaired vegetative status. Subgroups 1A and 2B took glutathione 100 mg twice a day with food for 3 months; subgroups 1B and 2A received ubiquinone 100 mg once a day with food for 3 months. In patients with CKD stage1–5, uUmod, albumin to creatinine ratio (ACR), glomerular filtration rate (GFR) were evaluated. Ninety-one ultrasound duplex color scans of the kidneys were performed and the index of resistance (IR) was determined in patients with CKD stage1–5. Results. The results of the paired t-test showed that there is a significant difference between the indicators at the beginning and at the end of the study, with the exception of the following: in subgroup 1A: hemoglobin (Hb) (T = –1.5863 [–2.0739, 2.0739] 95% confidence interval (CI) [–2.4077, 0.3207], p = 0.127); in subgroup 1B: Hb (T = –0.382 [–2.0739, 2.0739], 95% CI [–1.3977, 0.963], p = 0.706); ACR (T = –1.5899 [–2.0739, 2.0739], 95% CI [–16.7323, 2.2105], p = 0.126); systolic blood pressure (SBP) (T = –0.5625 [–2.0739, 2.0739], 95% CI [–2.2414, 1.2849], p = 0.579); diastolic blood pressure (DBP) (T = –1.7936 [–2.0739, 2.0739], 95% CI [–2.3437, 0.1698], p = 0.087); Chernov questionnaire (T = 1.5071 [–2.0739, 2.0739], 95% CI [–0.6083, 3.8431], p = 0.146); Kérdö index (T = 0.9392 [–2.0739, 2.0739], 95% CI [–1.1083, 2.9431], p = 0.358); in subgroup 2A: ACR (T = –2.0147 [–2.0796, 2.0796], 95% CI [–39.1946, 0.6219], p = 0.057); in subgroup 2B: ACR (T = –1.3328 [–2.0739, 2.0739], 95% CI [–17.4695, 3.7999], p = 0.196). The Pearson correlation results showed that in subgroup 1A, there is a significant average positive relationship between uUmod and eGFR (r(21) = 0.418, p = 0.047); a significant very small negative relationship between uUmod indicators and age (r(21) = 0.438, p = 0.037); in subgroup 1B, there is a significant large positive relationship between uUmod and Hb indicators (r(21) = 0.513, p = 0.012); a significant positive relationship between uUmod and Morisky Medication Adherence Scale-8 (MMAS-8) indicators (r(21) = 0.515, p = 0.012); a significant very small negative relationship between uUmod and ACR indicators (r(21) = 0.441, p = 0.035); in subgroup 2A, there is a significant very small negative relationship between uUmod indicators and Kérdö index (r(20) = 0.427, p = 0.048); in subgroup 2B, there is a significant very small negative relationship between the uUmod indicators and Chernov questionnaire score (r(21) = 0.421, p = 0.045); a significant very small negative relationship between uUmod indicators and Charlson Comorbidity Index (r(21) = 0.481, p = 0.020); a significant very small negative relationship between uUmod and age (r(21) = 0.471, p = 0.023). In subgroup 1A at the end of the study, the following independent variables are not significant as predictors for uUmod: IRd, IRs, SBP, DBP, Hb, ACR, age, Vein and Chernov questionnaires score, MMAS-8, Charlson Comorbidity Index and Kérdö index. In subgroup 1B at the end of the study, the following independent variables are not significant as predictors for uUmod: eGFR, IRs, SBP, DBP, Hb, Vein and Chernov questionnaires score, MMAS-8, Charlson Comorbidity Index and Kérdö index. In subgroup 2A at the end of the study, the following independent variables are not significant as predictors for uUmod: eGFR, IRd, IRs, SBP, DBP, Hb, ACR, age, Vein questionnaire score, MMAS-8, Charlson Comorbidity Index. In subgroup 2B at the end of the study, the following independent variables are not significant as predictors for uUmod: eGFR, IRd, IRs, SBP, DBP, Hb, ACR, age, Vein questionnaire score, ­MMAS-8, Kérdö index. Conclusions. Antioxidant therapy with glutathione and ubiquinone significantly affects the examination parameters of patients with CKD. Considering the safety and effectiveness of antioxidant therapy, we suggest including antioxidant therapy into the treatment protocols for patients with CKD. Further research is recommended to establish a standard protocol.","PeriodicalId":17874,"journal":{"name":"KIDNEYS","volume":"1 1","pages":""},"PeriodicalIF":0.0000,"publicationDate":"2023-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"1","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"KIDNEYS","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.22141/2307-1257.12.2.2023.403","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 1

Abstract

Background. The purpose of this study was to investigate urinary uromodulin (uUmod) excretion, reactivity of the autonomic nervous system and impaired renal blood circulation in patients with predialysis chronic kidney disease (CKD), and the effect of antioxidant therapy on these parameters. Materials and methods. Ninety-one patients with CKD stage 1–5 took part in the ROLUNT (UROmoduLin UbiquinoNe GlutaThione) study, their average age was 47.00 ± 12.12 years. Thirty (32.97 %) men and 61 (67.03 %) women were divided into two groups, which were representative in terms of age and gender composition: the first one (n = 46) — patients with CKD stage1–5 who had Charlson Comorbidity Index ≤ 2, the second one (n = 45) — patients with CKD stage1–5 who had Charlson Comorbidity Index ≥ 3. The first and second groups were divided into subgroups A and B. Subgroup A included patients with impaired vegetative status, subgroup B — without impaired vegetative status. Subgroups 1A and 2B took glutathione 100 mg twice a day with food for 3 months; subgroups 1B and 2A received ubiquinone 100 mg once a day with food for 3 months. In patients with CKD stage1–5, uUmod, albumin to creatinine ratio (ACR), glomerular filtration rate (GFR) were evaluated. Ninety-one ultrasound duplex color scans of the kidneys were performed and the index of resistance (IR) was determined in patients with CKD stage1–5. Results. The results of the paired t-test showed that there is a significant difference between the indicators at the beginning and at the end of the study, with the exception of the following: in subgroup 1A: hemoglobin (Hb) (T = –1.5863 [–2.0739, 2.0739] 95% confidence interval (CI) [–2.4077, 0.3207], p = 0.127); in subgroup 1B: Hb (T = –0.382 [–2.0739, 2.0739], 95% CI [–1.3977, 0.963], p = 0.706); ACR (T = –1.5899 [–2.0739, 2.0739], 95% CI [–16.7323, 2.2105], p = 0.126); systolic blood pressure (SBP) (T = –0.5625 [–2.0739, 2.0739], 95% CI [–2.2414, 1.2849], p = 0.579); diastolic blood pressure (DBP) (T = –1.7936 [–2.0739, 2.0739], 95% CI [–2.3437, 0.1698], p = 0.087); Chernov questionnaire (T = 1.5071 [–2.0739, 2.0739], 95% CI [–0.6083, 3.8431], p = 0.146); Kérdö index (T = 0.9392 [–2.0739, 2.0739], 95% CI [–1.1083, 2.9431], p = 0.358); in subgroup 2A: ACR (T = –2.0147 [–2.0796, 2.0796], 95% CI [–39.1946, 0.6219], p = 0.057); in subgroup 2B: ACR (T = –1.3328 [–2.0739, 2.0739], 95% CI [–17.4695, 3.7999], p = 0.196). The Pearson correlation results showed that in subgroup 1A, there is a significant average positive relationship between uUmod and eGFR (r(21) = 0.418, p = 0.047); a significant very small negative relationship between uUmod indicators and age (r(21) = 0.438, p = 0.037); in subgroup 1B, there is a significant large positive relationship between uUmod and Hb indicators (r(21) = 0.513, p = 0.012); a significant positive relationship between uUmod and Morisky Medication Adherence Scale-8 (MMAS-8) indicators (r(21) = 0.515, p = 0.012); a significant very small negative relationship between uUmod and ACR indicators (r(21) = 0.441, p = 0.035); in subgroup 2A, there is a significant very small negative relationship between uUmod indicators and Kérdö index (r(20) = 0.427, p = 0.048); in subgroup 2B, there is a significant very small negative relationship between the uUmod indicators and Chernov questionnaire score (r(21) = 0.421, p = 0.045); a significant very small negative relationship between uUmod indicators and Charlson Comorbidity Index (r(21) = 0.481, p = 0.020); a significant very small negative relationship between uUmod and age (r(21) = 0.471, p = 0.023). In subgroup 1A at the end of the study, the following independent variables are not significant as predictors for uUmod: IRd, IRs, SBP, DBP, Hb, ACR, age, Vein and Chernov questionnaires score, MMAS-8, Charlson Comorbidity Index and Kérdö index. In subgroup 1B at the end of the study, the following independent variables are not significant as predictors for uUmod: eGFR, IRs, SBP, DBP, Hb, Vein and Chernov questionnaires score, MMAS-8, Charlson Comorbidity Index and Kérdö index. In subgroup 2A at the end of the study, the following independent variables are not significant as predictors for uUmod: eGFR, IRd, IRs, SBP, DBP, Hb, ACR, age, Vein questionnaire score, MMAS-8, Charlson Comorbidity Index. In subgroup 2B at the end of the study, the following independent variables are not significant as predictors for uUmod: eGFR, IRd, IRs, SBP, DBP, Hb, ACR, age, Vein questionnaire score, ­MMAS-8, Kérdö index. Conclusions. Antioxidant therapy with glutathione and ubiquinone significantly affects the examination parameters of patients with CKD. Considering the safety and effectiveness of antioxidant therapy, we suggest including antioxidant therapy into the treatment protocols for patients with CKD. Further research is recommended to establish a standard protocol.
考虑合并症的透析前慢性肾病患者尿调素耐药及排泄指标评价
背景。本研究旨在探讨透析前慢性肾病(CKD)患者尿尿调节素(uUmod)排泄、自主神经系统反应性和肾血液循环受损,以及抗氧化治疗对这些参数的影响。材料和方法。91例1-5期CKD患者参加了ROLUNT (UROmoduLin UbiquinoNe GlutaThione)研究,平均年龄为47.00±12.12岁。将30例(32.97%)男性和61例(67.03%)女性分为年龄和性别构成具有代表性的两组:第一组(n = 46) - CKD分期1 - 5期患者,Charlson合并症指数≤2;第二组(n = 45) - CKD分期1 - 5期患者,Charlson合并症指数≥3。第一组和第二组分为A亚组和B亚组。A亚组包括有植物状态受损的患者,B亚组为无植物状态受损的患者。1A和2B亚组每日两次随食物服用谷胱甘肽100 mg,连续服用3个月;1B和2A亚组给予泛醌100 mg,每日1次,随食物一起服用,连续3个月。在CKD e1 - 5期患者中,评估umod、白蛋白与肌酐比值(ACR)、肾小球滤过率(GFR)。对91例CKD分期1 - 5期患者进行肾脏超声双彩色扫描,并测定其抵抗指数(IR)。结果。配对T检验结果显示,除1A亚组血红蛋白(Hb) (T = -1.5863[-2.0739, 2.0739] 95%置信区间(CI) [-2.4077, 0.3207], p = 0.127)外,研究开始和结束时各项指标均有显著差异;1B亚组:Hb (T = -0.382 [-2.0739, 2.0739], 95% CI [-1.3977, 0.963], p = 0.706);ACR (T = -1.5899[-2.0739, 2.0739], 95%可信区间[-16.7323,2.2105],p = 0.126);收缩压(SBP) (T = -0.5625 [-2.0739, 2.0739], 95% CI [-2.2414, 1.2849], p = 0.579);舒张压(DBP) (T = -1.7936 [-2.0739, 2.0739], 95% CI [-2.3437, 0.1698], p = 0.087);Chernov问卷(T = 1.5071 [-2.0739, 2.0739], 95% CI [-0.6083, 3.8431], p = 0.146);Kérdö指数(T = 0.9392 [-2.0739, 2.0739], 95% CI [-1.1083, 2.9431], p = 0.358);2A亚组:ACR (T = -2.0147 [-2.0796, 2.0796], 95% CI [-39.1946, 0.6219], p = 0.057);2B亚组:ACR (T = -1.3328 [-2.0739, 2.0739], 95% CI [-17.4695, 3.7999], p = 0.196)。Pearson相关结果显示,在1A亚组中,uUmod与eGFR存在显著的平均正相关(r(21) = 0.418, p = 0.047);uUmod指标与年龄呈极微小负相关(r(21) = 0.438, p = 0.037);在1B亚组中,uUmod与Hb指标呈显著正相关(r(21) = 0.513, p = 0.012);uUmod与Morisky用药依从性量表-8 (MMAS-8)指标呈显著正相关(r(21) = 0.515, p = 0.012);uudmod与ACR指标呈极微小负相关(r(21) = 0.441, p = 0.035);在2A亚组中,uUmod指标与Kérdö指数呈极微小的显著负相关(r(20) = 0.427, p = 0.048);在2B亚组中,uUmod指标与Chernov问卷得分呈极微小的负相关(r(21) = 0.421, p = 0.045);uUmod指标与Charlson共病指数呈极微小负相关(r(21) = 0.481, p = 0.020);uudmod与年龄呈极微小负相关(r(21) = 0.471, p = 0.023)。在研究结束时的1A亚组中,以下自变量作为uUmod的预测因子不显著:IRd、IRs、收缩压、舒张压、Hb、ACR、年龄、静脉和Chernov问卷评分、MMAS-8、Charlson合并症指数和Kérdö指数。在研究结束时的1B亚组中,以下自变量作为uUmod的预测因子不显著:eGFR、IRs、收缩压、舒张压、Hb、静脉和Chernov问卷评分、MMAS-8、Charlson合并症指数和Kérdö指数。在研究结束时的2A亚组中,以下自变量作为uUmod的预测因子不显著:eGFR、IRd、IRs、收缩压、舒张压、Hb、ACR、年龄、静脉问卷评分、MMAS-8、Charlson合并症指数。在研究结束时的2B亚组中,以下自变量作为uUmod的预测因子不显著:eGFR、IRd、IRs、SBP、DBP、Hb、ACR、年龄、静脉问卷评分、-MMAS-8、Kérdö指数。结论。谷胱甘肽和泛素抗氧化治疗显著影响CKD患者的检查参数。考虑抗氧化剂治疗的安全性和有效性,我们建议包括抗氧化治疗CKD患者治疗方案。建议进一步研究以建立标准方案。
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