THE INFLUENCE OF MELATONIN IN THE COMPLEX TREATMENT ON CLINICAL AND LABORATORY PARAMETERS ACTIVITY ANEMIA AND SYSTEMIC INFLAMMATION IN PATIENTS WITH CHRONIC KIDNEY DISEASE V D STAGE, WHO ARE TREATED WITH HEMODIALYSIS

  • Anna Petrova Bogomolets National Medical University, PhD, assistant
  • Vitalii Kondratyuk Bogomolets National Medical University, head of Department, MD, Professor
  • Olena Karpenko Bogomolets National Medical University, PhD, docent

Abstract

Introduction. The development and progression of chronic kidney disease (CKD) are associated with adverse changes in all areas of the life of patients on hemodialysis (HD). Despite significant advances in modern medicine, the search for improved treatment of anemia and systemic chronic inflammation in patients with HD is an urgent task today.
Goal. To analyze the effectiveness of the drug melatonin in patients with CKD stage V treated with hemodialysis to correct anemia and reduce inflammation, by adding it to standard treatment.
Materials and methods. 130 patients (50% of women) with stage 5 CKD undergoing hemodialysis were examined. According to the study design, depending on the functioning of the pineal gland and the treatment regimen, three groups of patients were formed. The main (I) group included 70 patients with CKD stage V treated with HD with impaired MFE, who received the drug MT before standard therapy. The comparison group IIa (n = 40) consisted of patients with CKD stage V with impaired MFE, who received standard therapy. The comparison group IIb (n = 20) included patients with CKD stage V with preserved MFE on standard therapy. All patients underwent clinical and laboratory studies at the start of treatment and after 8 weeks of treatment, which included general clinical and biochemical blood tests, and mandatory determination of melatonin concentration in saliva.
Results and discussion. The addition of melatonin to complex therapy in patients with HD shows a decrease in the manifestations of anemia (increased Hb by 14.3%, p <0.001), improved iron metabolism (increased transferrin by 12%, p <0.001), protein metabolism (increased albumin by 11.8%, p <0.001) and systemic inflammation (decrease in CRP levels by 3 times, p <0.001), which indicates the anti-inflammatory properties of MT and its ability to improve iron and protein metabolism, eliminating their deficiency.
Conclusions. The results of the study show a reduction in anemia and systemic inflammation in patients with Stage V Chronic Kidney Disease treated with HD by normalizing Hb levels, iron metabolism, CRP, ferritinand albumin with additional administration of MT to standard treatment of patients with HD. The obtained results confirm the data of other experimental studies, which demonstrated the antioxidant, anti-inflammatory and immunological properties of MT. A wide range of MT functions allows to recommend its additional appointment to the complex treatment of patients with Stage V Chronic Kidney Disease treated by hemodialysis.

References

1. Besarab A. Optimization of epoetin therapy with intravenous iron therapy in hemodialysis patients. J. Am. Soc. Nephrol. 2000. № 11, P. 530-538
2. Zaritsky J. et al. Hepcidin – a potential novel biomarker for iron status in chronic kidney disease. Clin. J. Am. Soc. Nephrol. 2009. №4, P. 1051-1056.
3. Кондратюк В.Є., Петрова А.С., Карпенко О.В. Клінічна оцінка порушень мелатонінутворювальної функції епіфізу та анемії у хворих на хронічну хворобу нирок 5 стадії, що лікуються гемодіалізом. Нирки. 2020. 9(1): 20-28.
4. Kolesnyk MO, hol. redaktor. Natsionalnyi reiestr khvorykh na khronichnu khvorobu nyrok ta patsiientiv z hostrym poshkodzhenniam nyrok: 2017 rik / uklad. NI Kozliuk, SS Nikolaienko, OО Razvazhaieva; Derzhavna ustanova «Instytut nefrolohii NAMN Ukrainy». Kyiv, 2018.183 s. [In Ukrainian].
5. Pisoni R.L. Anemia management and outcomes from 12 countries in the Dialysis Outcomes and Practice Patterns Study (DOPPS). Am J Kidney Dis. 2004. № 44, P. 94-111.
6. U.S. Renal Data System, USRDS 2013 Annual Data Report: Atlas of Chronic Kidney Disease and EndStage Renal Disease in the United States, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, 2013.
7. A. L. M. de Francisco et all. Francisco Inflammation and its impact on anaemia in chronic kidney disease: from haemoglobin variability to hyporesponsiveness. Nephrology Dialysis Transplantation. 2009. 2(1): 18-26.
8. Cobo G, Lindholm B, Stenvinkel P. Chronic inflammation in end-stage renal disease and dialysis. Nephrol Dial Transplant. 2018. 33 (suppl_3)
9. Ito S, Higuchi Y, Yagi Y, Nishijima F, Yamato H, et al. (2013) Reduction of indoxyl sulfate by AST-120 attenuates monocyte inflammation related to chronic kidney disease. J Leukoc Biol 93: 837–845.
10. Nowak KL, Chonchol M. Does inflammation affect outcomes in dialysis patients. Semin Dial. 2018. 31(4):388–397. doi:10.1111/sdi.12686
11. Panichi V. Chronic Inflammation and Mortality in dialysis: Effect of Different Renal Replacement Therapies. Results from the RISCAVID Study. Nephrol Dial Transplant. 2008. 23(7): 2337-2343.
12. Ronco C (ed): Expanded Hemodialysis – Innovative Clinical Approach in Dialysis. Contrib Nephrol. Basel, Karger, 2017. 191: 32-43. doi: 10.1159/000479254
13. Wang CP, Lu LF, Yu TH, Hung WC, Chiu CA, et al. (2013) Associations among chronic kidney disease, high total p-cresylsulfate and major adverse cardiac events. J Nephrol 26: 111–118.
14. Labonia W., Rubio D., Arias C. Melatonin corrects reticuloendothelial blockade and iron status in haemodialysed patients. Article in Nephrology. 2005. 10(6).
15. Kondratiuk V.E., Petrova A. S., Karpenko О.V. Kharakterystyka melatoninutvoriuvalnoi funktsii epifiza u patsiientiv z khronichnoiu khvoroboiu nyrok u terminalnii stadii.. Klinichna endokrynolohiia ta endokrynna khirurhiia 4 (68) 2019, 94-102
16. ESRD patients in 2013 «A Global Perspective» [Електронний ресурс]. – Режим доступу: http://www.usrds.org/2013/pdf/v2_ch1_13.pdf.
17. Likuvannia khvorykh na z khronichnu khvorobu nyrok V HD stadii. Adaptovana klinichna nastanova, zasnovana na dokazakh ta unifikovani klinichni protokoly. – K.: «Polihraf plius», 2016. – 228 s. [In Ukrainian].
18. Петрова А.С. Ефективність мелатоніну в складі комплексної терапії хворих на хронічну хворобу нирок V стадії: дис. доктора філософії з галузі знань 22 «Охорона здоров’я».: ДФ 26.003.019 /Анна Сергіївна Петрова; НМУ імені О.О. Богомольця – Київ, 2020.
Published
2021-12-14
How to Cite
Petrova , A., Kondratyuk , V., & Karpenko , O. (2021). THE INFLUENCE OF MELATONIN IN THE COMPLEX TREATMENT ON CLINICAL AND LABORATORY PARAMETERS ACTIVITY ANEMIA AND SYSTEMIC INFLAMMATION IN PATIENTS WITH CHRONIC KIDNEY DISEASE V D STAGE, WHO ARE TREATED WITH HEMODIALYSIS. Actual Problems of Nephrology, (29), 58-65. https://doi.org/10.37321/nefrology.2021.29-06