Abstract:
Introduction. Chronic kidney disease (CKD) is a global health priority due to
its high prevalence (9-12% of the adult population), relentless progression, and early
disability. The progression of CKD to end-stage renal disease (CKD stage 5)
involves a complex interplay of hemodynamic, inflammatory, and metabolic
factors. Key pathogenetic mechanisms include disturbances in nutritional status
(protein-energy wasting, sarcopenia), an imbalance in the matrix metalloproteinase
(MMP) system leading to renal fibrosis, and genetically determined features of the
renin-angiotensin-aldosterone system (RAAS). Despite current treatment standards,
CKD progression rates remain high, highlighting the need for an integrated,
personalized approach combining nutritional, molecular, and genetic markers.
Objective: To study the characteristics of nutritional status and matrix
metalloproteinase levels in CKD, evaluate their role in the development of end-stage
renal disease, and based on the findings, develop methods for the correction and
prevention of disease progression.
The study included 576 CKD patients observed in a
nephrology hospital from 2021 to 2023. The study design was combined
(retrospective and prospective). The retrospective group consisted of 423 patients
for clinical course analysis. The prospective group included 153 patients who
underwent in-depth examination. Methods included: clinical-anamnestic,
anthropometric (BMI, waist circumference), nutritional status assessment using the
Subjective Global Assessment (SGA) scale, instrumental methods (Doppler
ultrasound of renal arteries with resistance index RI calculation, bioimpedance
analysis), laboratory methods (eGFR, proteinuria, ferritin, vitamins B6, D, and folic
acid), and molecular-genetic methods (genotyping of AGTR1 A1166C and AGTR2
G1675A polymorphisms, measurement of MMP-2 and MMP-9 levels). Statistical
analysis included parametric and non-parametric methods, logistic regression, and
ROC analysis.
