Ciceri Paola, Artioli Luisa, Magagnoli Lorenza, Barassi Alessandra, Alvarez Jean-Claude, Massy Ziad A, Galassi Andrea, Cozzolino Mario
Department of Health Sciences, Laboratory of Experimental Nephrology, University of Milan, Milan, Italy.
Renal Division, Department of Health Sciences, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy.
Blood Purif. 2023;52(1):41-53. doi: 10.1159/000524335. Epub 2022 May 5.
In chronic kidney disease (CKD), the high morbidity and mortality risk for cardiovascular disease (CVD) are not easily explained only on the basis of traditional factors. Among nontraditional ones involved in CKD, malnutrition, inflammation, and atherosclerosis/calcification have been described as the "MIA syndrome."
In this pilot study, we evaluated the association between the variation in serum levels of 27 uremic retention solutes plus 6 indexes related to the MIA syndrome processes in a population of dialysis patients.
As expected, we found a direct correlation between serum albumin and both phosphate and total cholesterol (r = 0.54 and 0.37, respectively; p < 0.05). Moreover, total cholesterol and phosphate directly correlate (r = 0.40, p < 0.05). The relationship between malnutrition and inflammation is highlighted by the correlation of serum cholesterol levels with serum alpha-1 acid glycoprotein and IL-6 levels (r = -0.56, r = -0.39, respectively; p < 0.05). Moreover, the relation between inflammation and atherosclerosis/calcification is supported by the correlation of IL-6 with VEGF levels and vascular smooth muscle cell high-Pi in vitro calcification (r = 0.81, r = 0.66, respectively; p < 0.01).
We found significant correlations between several uremic retention solutes and malnutrition, inflammation, and atherosclerosis/calcification. Our findings support the hypothesis of a central role of the uremic milieu in the MIA syndrome and ultimately in the pathogenesis of CKD-specific CVD risk factors.
在慢性肾脏病（CKD）中，心血管疾病（CVD）的高发病率和高死亡率风险仅基于传统因素难以轻易解释。在参与CKD的非传统因素中，营养不良、炎症和动脉粥样硬化/钙化被描述为“MIA综合征”。
在这项初步研究中，我们评估了透析患者群体中27种尿毒症潴留溶质的血清水平变化与6个与MIA综合征过程相关指标之间的关联。
正如预期的那样，我们发现血清白蛋白与磷酸盐和总胆固醇之间存在直接相关性（分别为r = 0.54和0.37；p < 0.05）。此外，总胆固醇和磷酸盐直接相关（r = 0.40，p < 0.05）。血清胆固醇水平与血清α-1酸性糖蛋白和IL-6水平的相关性（分别为r = -0.56，r = -0.39；p < 0.05）突出了营养不良与炎症之间的关系。此外，IL-6与VEGF水平以及血管平滑肌细胞体外高磷钙化的相关性（分别为r = 0.81，r = 0.66；p < 0.01）支持了炎症与动脉粥样硬化/钙化之间的关系。
我们发现几种尿毒症潴留溶质与营养不良、炎症和动脉粥样硬化/钙化之间存在显著相关性。我们的研究结果支持了尿毒症环境在MIA综合征中以及最终在CKD特异性CVD危险因素发病机制中起核心作用的假设。
