Importance of activity of autophagy, apoptosis and intracellular protein degradation for early detection of malnutrition in patients with chronic kidney disease of 5th stage, receiving of hemodialysis: the results of case-control study

Malnutrition significant affects the flowing and prognosis of chronic kidney disease (CKD) of 5th stage. It’s early detection with assistance is actual problem. Purpose. Detect of more sensitive markers for diagnostic assessment of malnutrition and elucidate of availability of autophagy, apoptosis and intracellular protein degradation’ markers for the purpose. Methods. It was made prospective case-control study. CKD of 5^th stage’ patients with hemodialysis were included. Objective, laboratory study (n = 106) and detection of Beclin-1, 20S-proteasoma and Bcl-2’ levels (n = 80) prepared. Last three of them indicated of autophagy, intracellular protein degradation and apoptosis activity appropriately. We had two groups: with malnutrition (n = 93/71) and without it (n = 93/71). Results. Variability of malnutrition’ quantity, depending on index for verification of it was detected: for index “lymphocytes < 1 800” – 71,1% (59 of 83 investigated patients), “transferrin saturation < 20” – 34% (36 of 106), “serum albumin < 35 g/l” – 1,9% (2), “body mass index < 18,5” – 0,9% (1), “body mass deficit” – 5,7% (6). High level of 20S-proteasome (46,2-72,5 ng/ml) increased of malnutrition chance (OR = 4,88 [95% CI = 1,09–21,84]). Somatic protein pool insufficiency was more frequently, than visceral pool is in malnutrition group: 25,8% (24 of 93) и 2,2% (2 of 93; р < 0,05). Objective. Biomarkers can find malnutrition earlier than anthropometric indexes, and high level of 20S-proteasome can be early independent predictor of malnutrition.