A cute plasma ghrelin and leptin responses to oral feeding or intraperitoneal hypertonic glucose-based dialysate in patients with chronic renal failure

Perez-Fonten, Miguel; Cordido, Fernando; Rodreguez-Carmona, A.N.A.; Garcea-Naveiro, Rafael; Isidro, M.; Villaverde, Pedro; Garcea-Buela, JeseS

doi:10.1111/j.1523-1755.2005.00761.x

Cited by 43 publications

(38 citation statements)

References 61 publications

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“…We demonstrate that levels of DG but not AG increase with declining eGFR, and that ghrelin metabolism or secretion may be altered by uremia. AG response to feeding was blunted in CKD and absent in ESRD participants, as also reported by others (24,25). These results suggest that AG secretion is within the normal range and its conversion to DG is normal, but DG accumulates as its clearance is progressively decreased with declining eGFR.…”

Section: Discussionsupporting

confidence: 68%

“…In our studies in CKD, the decrease in postprandial levels was blunted, but the ratio of DG/AG was maintained, and there was actually an increase in DG postprandially in dialysis patients. Others have reported that AG metabolism was altered in dialysis patients, but did not report data on DG (24,25). Our findings suggest that not only is DG increased as eGFR declines, but that abnormalities in the response of the ghrelin axis to feeding occur as CKD develops.…”

Section: Discussionmentioning

confidence: 49%

“…This was exaggerated in ESRD, in which there was no significant change in either DG or AG postprandially in dialysis patients (Figure 2). Peréz-Fontan et al and Suneja et al likewise reported perturbation in the expected responses to feeding in dialysis patients as noted above (24,25) Ghrelin levels are increased in states of severe malnutrition and decreased in states of satiety (7,30,31). Ghrelin has potent orexigenic activity and induces an increase in food intake, and muscle mass with a positive change in energy uremic balance in rats (32)(33)(34).…”

Section: Discussionmentioning

confidence: 98%

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Association of Plasma Des-acyl Ghrelin Levels with CKD

Gupta

Kuppusamy²,

Patrie

et al. 2013

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives There are no effective therapies for malnutrition in CKD/ESRD patients. This study hypothesized that ghrelin, an endogenous orexigenic hormone, would correlate with renal function and might suggest therapeutic interventions for CKD/ESRD malnutrition.Design, setting, participants, & measurements Fifty-one CKD and 15 hemodialysis patients were enrolled. Acyl ghrelin (AG) and des-acyl ghrelin (DG) were determined using separate two-site-specific assays. Leptin, insulin, growth hormone, insulin-link growth factor-1, C-reactive protein, TNF-a, and IL-6 were also measured.Results Univariate correlation analyses showed that CKD stage was highly, positively correlated with the levels of preprandial and postprandial DG and positively correlated with TNF-a, IL-6, leptin, and age. Multivariate partial-correlation analyses showed that CKD was independently associated with the proportion of preprandial and postprandial DG, whereas TNF-a, IL-6, leptin, insulin, and age were not independently associated with either. Geometric mean (GM) preprandial and postprandial AG were comparable between CKD stages #2 and .2, whereas GM preprandial DG and postprandial DG were 1.95-fold and 2.17-fold greater, respectively, for CKD stage .2 versus stage #2. DG was the dominant form of ghrelin preprandially and postprandially for both CKD stages #2 and .2. Dialysis had no effect on AG, but reduced DG by 73% to levels even lower (GM 48.7 pg/ml) than those seen postprandially in CKD stage #2 patients (GM 77.0 pg/ml).Conclusions This study shows a strong and independent correlation of DG with CKD stage. Postprandial suppression of ghrelin is impaired with reduced renal function. Hemodialysis selectively removes DG but not AG.

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Section: Discussionsupporting

confidence: 68%

Section: Discussionmentioning

confidence: 49%

Section: Discussionmentioning

confidence: 98%

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Association of Plasma Des-acyl Ghrelin Levels with CKD

Gupta

Kuppusamy²,

Patrie

et al. 2013

Clinical Journal of the American Society of Nephrology

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“…However, it must be acknowledged that the effects of des-acyl ghrelin on food intake regulation still need to be better elucidated since the available evidence appears controversial [19, 20, 33]. Indeed, a recent paper by Perez-Fontan et al [34] showed a blunted response of both total and acylated ghrelin to oral intake in peritoneal dialysis patients. These data seem to suggest that in uremic patients ghrelin’s stimulatory and inhibitory pathways are disturbed, leading to increased levels of des-acyl-ghrelin promoting/maintaining reduced appetite and food intake.…”

Section: Discussionmentioning

confidence: 99%

Anorexia in Hemodialysis Patients: The Possible Role of Des-Acyl Ghrelin

et al. 2007

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Background: Anorexia is frequently found in end-stage renal disease and is a reliable predictor of morbidity and mortality in hemodialysis (HD) patients. The pathogenesis of anorexia is complex and the appetite-modulating hormone ghrelin could be involved. Two forms of circulating ghrelin have been described: acylated ghrelin (<10% of circulating ghrelin) which promotes food intake, and des-acyl ghrelin which induces a negative energy balance. The aim of this cross-sectional study is to clarify whether anorexia and body weight change in HD patients relate to plasma des-acyl ghrelin levels. Methods: 34 HD patients and 15 healthy controls were studied. The presence of anorexia was assessed by a questionnaire. Serum des-acyl ghrelin was measured in HD patients and in 15 body mass index-, sex- and age-matched controls by ELISA. Energy intake was assessed by a 3-day dietary diary, and fat-free mass (FFM) was evaluated by body impedance analysis. Data have been statistically analyzed and are presented as mean ± SD. Results: 14 patients (41%) were found to be anorexic, and 20 patients (59%) non-anorexic. Energy intake (kcal/day) was significantly lower in anorexic than in non-anorexic patients (1,682 ± 241 vs. 1,972.50 ± 490; p < 0.05). FFM (%) was lower in anorexic than in non-anorexic patients (65.8 ± 4.4 vs. 70.9 ± 8.7; p = 0.05). Plasma des-acyl ghrelin levels (fmol/ml) were significantly higher in HD patients than in controls (214.88 ± 154.24 vs. 128.93 ± 51.07; p < 0.05), and in anorexic HD patients than in non-anorexic (301.7 ± 162.4 vs. 159.1 ± 115.5; p < 0.01). Conclusion: Anorexia is highly prevalent among HD patients and des-acyl ghrelin could be involved in its pathogenesis.

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“…The sensitivity of the assay was 1 µU/ml, and the normal value was <17 µU/ml. (2) Serum GLP-1 [7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36] was quantified using a commercial enzyme immunoassay kit (DRG International, USA). The intra- and interassay coefficients of variation were <5 and <14%, respectively, and the sensitivity of the assay was 0.10 ng/ml.…”

Section: Methodsmentioning

confidence: 99%

Acute Responses of Gastrointestinal Hormones to Both Oral and Parenteral Intradialytic Nutrition

et al. 2010

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Introduction: Intradialytic nutrition (IDN) has been used to improve the nutritional status of malnourished hemodialysis (HD) patients. Objective: To evaluate the different effects of parenteral IDN (IDPN) and oral IDN (IDON) on nutrition-related gastrointestinal hormones. Patients and Methods: Seven clinically stable HD patients with malnutrition were included. All patients were treated for 1 month with either IDPN or IDON, with a 4-week period of no nutritional support between each type of therapy. On the first day of each nutritional support (IDON or IDPN) we analyzed the acute responses of insulin, ghrelin, and glucagon-like peptide 1 (GLP-1). We compared the areas under the secretory curves (AUC) and the maximum peaks of serum glucose, insulin, ghrelin, and GLP-1. A group of 6 clinically stable HD patients without any type of IDN served as the control group. Results: The acute responses of glucose and insulin to IDN were significantly higher with IDPN than with IDON. The AUC of glucose (602 ± 81 vs. 495 ± 81 mg/dl/h, p < 0.01) and insulin (232 ± 103 vs. 73.8 ± 69 µU/ml/h, p < 0.01) as well as the maximum peaks of glucose (228 ± 41 vs. 177 ± 47 mg/dl, p < 0.05) and insulin (104 ± 46 vs. 29 ± 24 µU/ml, p < 0.01) were significantly higher after IDPN than after IDON. Ghrelin decreased after both IDPN and IDON; however, the decrease was significantly higher with IDPN compared to IDON. The ghrelin nadir was significantly lower in IDPN than in IDON (0.77 ± 0.5 vs. 1.5 ± 0.3, p < 0.05) although the AUC of ghrelin was not significantly different. GLP-1 was significantly increased at 1 h after starting both IDPN and IDON with no significant differences between the groups. Conclusion: IDPN induces a higher increase in serum glucose and insulin levels and a greater reduction in serum ghrelin concentrations compared with an equivalent orally administered nutritional supplement.

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A cute plasma ghrelin and leptin responses to oral feeding or intraperitoneal hypertonic glucose-based dialysate in patients with chronic renal failure

Cited by 43 publications

References 61 publications

Association of Plasma Des-acyl Ghrelin Levels with CKD

Association of Plasma Des-acyl Ghrelin Levels with CKD

Anorexia in Hemodialysis Patients: The Possible Role of Des-Acyl Ghrelin

Acute Responses of Gastrointestinal Hormones to Both Oral and Parenteral Intradialytic Nutrition

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