STUDIO DELL¿EFFETTO DELLA SUPPLEMENTAZIONE DI CURCUMINA IN PAZIENTI AFFETTI DA INSUFFICIENZA RENALE CRONICA

Introduction.The definition of Chronic Kidney Disease (CKD) was developed in 2012 by Kidney Disease: Improving Global Outcomes (KDIGO) and is associated with the presence of abnormalities in the structure and function of the kidney that persist for at least 3 months with implications for health of thepatient. The identification of the first alterations in renal function, changes in body composition and nutritional status in renal patients, are the basis for the correct diagnosis of Chronic Kidney Disease. Aim.The aim of the study was to understand the interaction between nutritional and inflammatory status in CKD patients. In particular, the study aims to investigate the action of curcumin supplementation for 3 or 6 months with particular attention to inflammation markers and changes in the intestinal microbiome. Population and Methods.An intervention study was carried out at the San Paolo Hospital in Milan on a population of 24 patients with CKD in conservative therapy who were administered curcumin for 3 and 6 months of treatment. The blood chemistry tests for the evaluation of renal function were evaluated, the nutritional status was evaluated through the analysis of the body composition (BMI, waist circumference and bioimpedance analysis), while, the insertion of the 3-day food diaries were analyzed by means of the EphoodTM software, in order to carry out the bromatological analysis of food intake. Blood samples were collected and inflammatory cytokines analyzed (ELISA) to assess the patients' inflammatory status. Patient feces were also collected in order to analyze the patients' microbiome during the progression of the disease and the administration of curcumin. Results.Body composition analysis showed a reduction in fat mass (p-value <0.0001), and an improvement in lean mass and a slight decrease in BMI from time T0 to time T1, and also between time T1 and time T2. The blood chemistry parameters remain within the normal range for the entire duration of the study, this is an indication of a good compensation of the disease, both from a pharmacological and dietary point of view. From the analysis of pro-inflammatory cytokines at serum level, it emerged that the levels of CCL2 were statistically significantly reduced and after six months of treatment the IFN-γ and IL-4 values also decreased, confirming the anti-inflammatory effect of curcumin supplementation, also described extensively in the scientific literature. From the analysis of the intestinal microbiota there were no statistically significant data. From the α-diversity analysis, the control group showed a higher dysbiosis condition than the group with CKD, probably linked to pathologies related to the age of our control group. Conclusions.The increase in the incidence of CKD is mainly linked to the general aging of the population and the consequent aging of the kidney, together with the presence of other diseases: cardiovascular diseases, obesity and metabolic syndrome. The high average age of our population (71 years) highlighted the limitations of the study that would have helped to determine the low compliance found in the intake of curcumin and the low motivation in continuing the study for the entire duration of the study. To better understand the data obtained from the taxonomic analysis of the intestinal microbiota, studies are underway that aim to relate the nutritional intake with the characteristics of the microbiota composition of the patient with CKD.