SUMMARY
The role of chronic inflammation in the early stages of the disease, as well as the influence of increasing body weight on the inflammatory status in adults, significantly expanded its importance in CKD.
The purpose of the work is to study the role of systemic inflammation, ghrelin in the pathogenesis of nephropathy and CKD against the background of obesity in the early stages.

Patients were divided into 2 groups depending on the degree of obesity: the first group consisted of 72 patients with obesity of stage 1 and CKD and the second group – 86 patients with obesity of stage 2 and CKD. The control group consisted of 10 healthy individuals. All patients were determined waist circumference (WC), hip circumference (HC) and their ratios, calculated the glomerular filtration rate (GFR) according to CKD-EPI formulas based on levels of creatinine, cystatin C and their combination (CKD-EPIcysC / cr) (ml / min / 1.73 m2). The level of cystatin C, quantitation of C-reactive protein, the concentration of tumour necrosis factor-alpha (TNF-α) and ghrelin in blood serum were determined by enzyme-linked immunosorbent assay methods.
As the BMI increased, there was a decrease in renal function: in patients with CKD against the background of obesity of stage 2 the GFR CKD-EPI cysC / cr index was 1.35 times lower compared to the healthy individuals (p2 < 0.001) and was 1.12 times lower compared to the same index of group 1 (p1 < 0.05), indicating a decrease filtration function of the kidneys against the background of obesity. In patients of group 2 were determined the average negative correlation between the GFR CKD-EPI cysC / cr and the BMI – r2 = –0.68 (p < 0.05), and between the GFR and the WC / HC – r2 = –0.63 (p > 0.05). In both groups there was detected an increased level of CRP – 5.9 and 9.8 times, respectively, compared with the healthy individuals (p1.2 < 0.05). There was a weak inverse correlation between the GFR and the CRP levels in patients of group 1 – r1 = –0.34 (p > 0.05) and the average inverse correlation between these indexes in patients of group 2 – r2 = –0.45 (p < 0.05). There was also a positive correlation between the level of CRP and the WC in both groups – r1 = 0.38 and r2 = 0.68 (p2 < 0.05) and between the CRP and the BMI – r1 = 0.66 and r2 = 0, 78 (p1.2 < 0.05). There was determined an increased level of TNF-α – 3.6 times in patients of group 1 and 5.8 times in patients of group 2 compared the healthy individuals (p1,2 < 0.001). In patients of group 2, the level of TNF-α was 1.6 times higher than in patients of group 1 (p2 < 0.05). There were also determined the average positive correlation between the TNF-α and the BMI in patients of group 1 – r1 = 0.60 (p1 < 0.01) and group 2 – r2 = 0.69 (p2 < 0.05) and the average inverse correlation between GFR and the level of TNF-α in patients of group 2 – r2 = 0.67 (p2 < 0.05). At the same time, there was established a strong positive correlation between the level of CRP and TNF-α in patients of group 2 – r2 = 0.78 (p2 < 0.05). The study of the level of total ghrelin in blood serum of patients of group 1 showed a significant increase of 1.4 times (p1 < 0.05) compared with the healthy individuals, and in patients of group 2 on the contrary there was a significant decrease of 1.2 times (p2 < 0.01). The decrease in glomerular filtration rate in patients of both groups had an average inverse correlation with the level of ghrelin, respectively, r1 = –0.53, t = 2.1, r2 = –0.55, t = 2.3 (p1, 2 < 0.05). There were determined the average negative correlation between the concentration of the ghrelin and the CRP in patients of both groups (r1 = –0.51, t = 2.1 and r2 = –0.54, t = 2.7 (p1.2 < 0.05)), and with the TNF-α – r1 = –0.51, t = 2.5 and r2 = –0.54, t = 2.4 (p1.2 < 0.05).
Conclusion: There is a close relationship between markers that characterize obesity and individual indicators of inflammation, in particular, C-reactive protein and tumour necrosis factor-alpha. Renal dysfunction progresses against this background, as indicated by a decrease in CKD-EPIcysC / cr. In these processes ghrelin stimulates appetite, promotes the progression of obesity and reduces the rate of glomerular filtration. Decreased ghrelin levels and increased levels of pro-inflammatory cytokines indicate a process of low-intensity inflammation in the early stages of chronic kidney disease.
Key words: chronic kidney disease, obesity, inflammation, C-reactive protein, tumour necrosis factor-alpha, ghrelin.
Lek Obz, 2021, 70 (5): 189-194

Práca vyšla v anglickom jazyku
Nataliia Vasylivna GUBINA 1, Vasyl Hryhorovych MISHCHUK 1, Iryna Hryhorivna KUPNOVYTSKA 1, Halyna O. STUPNITSKA 2

1 Department of Clinical Pharmacology and Pharmacotherapy, Ivano-Frankivsk National Medical University of Ministry of Health of Ukraine, Ivano-Frankivsk City, Ukraine
2 Bukovynian State Medical University, Chernivtsi City, Ukraine

Cite:
GUBINA N.V., MISHCHUK V.H., KUPNOVYTSKA I.H., STUPNITSKA H.O.:   Sporadic inflammatory markers and ghrelin levels in patients with early stages of chronic kidney disease against the background of obesity. Lek Obz, 2021, 70 (5): 189-194