Association of genetic variants of ghrelin, leptin and UCP2 with malnutrition inflammation syndrome and survival in end-stage renal disease patients

Agrawal, Suraksha; Saxena, Anita; Pandey, Manmohan Krishna; Sharma, Richa

doi:10.1007/s12263-013-0353-7

Cited by 14 publications

(11 citation statements)

References 43 publications

(40 reference statements)

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“…In agreement, previously, it has been already reported that leptin levels were elevated in advanced renal disease patients with normal and mild malnutrition, although leptin was found to be lower in severe and moderate category of malnutrition score [19]. In ESRD patients malnutrition and hypoalbuminemia are common and powerful predictors of morbidity and mortality of these patients [20].…”

Section: Discussionsupporting

confidence: 87%

“…In ESRD patients malnutrition and hypoalbuminemia are common and powerful predictors of morbidity and mortality of these patients [20]. The decreased serum levels of leptin in severe category of malnutrition group might be associated with acquired leptin receptor resistance [19]. Reversely, the lower leptin levels may be implicated to the pathways for hypertension and worsen nutritional and metabolic state in dialysis patients.…”

Section: Discussionmentioning

confidence: 99%

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Leptin and hypertension in non-obese patients in renal replacement therapy

Raikou¹,

Kyriaki²

2017

Integr Obesity Diabetes

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Background: The real role of leptin on the vascular disease in end stage of renal disease patients is complicated rather than clear. We considered the relationship between leptin serum concentrations and manifested hypertension in non-obese patients in intermittent dialysis therapy. Methods:We studied 76 patients in on-line hemodiafiltration. Dialysis adequacy was defined by Kt/V for urea. Leptin and i-parathormone (i-PTH) were measured by radioimmunoassay. Metabolic acidosis was determined by serum bicarbonate concentrations less than 22mmol/L. We recorded the home blood pressure according to a standard protocol and it was verified by 24-h monitoring. Antihypertensive treatment was noted. Chi-square tests and adjusted model were performed for the role of leptin on established hypertension.Results: Chi-square tests showed significant association between hypertension and both, low leptin and low bicarbonate (x 2 =12.4, p=0.001 and x 2 =13.1, p=0.001 respectively) and it was supported by the built adjusted model. The patients with hypertension had significantly lower leptin, hemoglobin, normalized protein catabolic rate (nPCR) as a marker of protein intake and bicarbonate levels, but similar dialysis dose than the patients without hypertension. The patients with high leptin had significantly decreased blood pressure, but higher i-PTH, bicarbonate levels and liquids overload in combination with similar dialysis sufficiency comparatively to the patients with low leptin. Conclusion:Hypertension was significantly associated with low leptin in non-obese dialysis patients. In spite of apparently adequate dialysis dose, the involved factors in this relationship may be malnutrition and uncontrolled metabolic acidosis state, although the usage of antihypertensive treatment may play an additional role. Material and Methods SubjectsThis is a dual-center observational cross-sectional study of a cohort of 76 non-obese according to calculated BMI (<25 kg/m 2 ) patients in permanent hemodiafiltration therapy. Patients < 18 years of age at initiation of dialysis treatment, those with less than 6 months of followup, autoimmune diseases, infections, malignancy and patients without regular vascular hemodialysis access and who had dialysis catheter were not included in the study.We enrolled 47 males and 29 females, on mean age 62.2 ± 15 years old, permanently treated by on-line-predilution hemodiafiltration (on-l HDF). The median time in hemodiafiltration treatment was 5 ± interquartile range 3-10 years. The hemodiafiltration treatment was performed 3-times weekly with a dialysis time of 3.5-4 h per session, a Raikou VD (2017) Leptin and hypertension in non-obese patients in renal replacement therapy

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Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Leptin and hypertension in non-obese patients in renal replacement therapy

Raikou¹,

Kyriaki²

2017

Integr Obesity Diabetes

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“…Vaia D. Raikou although were lower in severe and moderate category of malnutrition score [11] in agreement with other previous findings [12] . The decreased serum levels of leptin in severe category of malnutrition group might be associated with acquired leptin receptor resistance [11] .…”

Section: Which Is the Role Of Leptin On Patients In The End Stage Of supporting

confidence: 92%

“…The decreased serum levels of leptin in severe category of malnutrition group might be associated with acquired leptin receptor resistance [11] . However, it has been showed that the levels of acyl ghrelin were lowest in the severe group of malnutrition [11] . Ghrelin is an appetite stimulating hormone and transduces signals to hypothalamic regulatory nuclei that control energy homeostasis.…”

Section: Which Is the Role Of Leptin On Patients In The End Stage Of mentioning

confidence: 98%

“…Ghrelin is shown to enhance food intake in dialysis patients with mild to moderate malnutrition [13] . It has been reported that low acyl ghrelin is associated with poor nutritional status and loss of appetite [14] .Leptin, ghrelin and uncoupling protein2 (UCP2) gene polymorphisms are the molecules which implicated in the appetite-energy regulatory pathway of the malnutrition-inflammation syndrome in ESRD [11] .…”

Section: Which Is the Role Of Leptin On Patients In The End Stage Of mentioning

confidence: 99%

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Which is the Role of Leptin on Patients in the End Stage of Renal Disease?

Raikou

2015

Journal of Nephrology Research

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family of cytokines, related to diminished food intake. Since leptin is mainly secreted by adipose tissue, serum leptin levels are directly proportional to adipocyte mass. Apart from metabolism, leptin has systemic effects including regulation of angiogenesis, wound healing, lipolysis, blood pressure homeostasis, reproduction, hematopoiesis and immune function [2,3] . The current studies provide evidence that the real role of leptin on the patients in end stage of renal disease is complicated rather than clear. LEPTIN, INFLAMMATION, MALNUTRITION AND INSULIN RESISTANCEIt has been already recognized that a substantial number of patients with end-stage renal disease have serologic evidence of an activated inflammatory state [4] . Previously, the leptin receptor has been identified on endothelial cells, and leptin has been reported to promote both angiogenesis and inflammation [5] . Leptin modifies the systemic inflammatory response and the inflammatory microenvironement in renal disease may be associated with elevated expression of leptin gene [6] . However, there is a discrepancy for the relationship of leptin levels with chronic inflammation and it has been supported that leptin may be a negative acute phase protein in chronic hemodialysis patients [7] . On the other hand, leptin suppresses appetite and increases energy expenditure, playing a homeostatic role in the regulation of food intake and in maintaining body composition in general population [8] . In patients with end-stage renal disease malnutrition and hypoalbuminemia are common and powerful predictors of morbidity and mortality in this population [9] . One potential relationship between malnutrition and inflammation in renal disease patients is appetite suppression and the link between inflammation and anorexia may be through the leptin [10] . However, it has been already supported that inflammation is unlikely to reduce appetite causing malnutrition in dialysis patients through a leptin-mediated mechanism, because leptin is a negative rather than a positive acute phase protein in this population of patients [7] . Also, recent study reported that leptin levels were elevated in ESRD patients with normal and mild malnutrition, ABSTRACTLeptin is a small peptide hormone (16 kDa), a product of the obesity gene (Ob), and is mainly synthesized and secreted by adipocytes.In this review paper the main points of the leptin role on the end stage of renal disease is out lined.

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