Irisin and Volume Overload are Associated with Protein Energy Wasting in Peritoneal Dialysis Patients

Abstract

Background/Aims: Protein energy wasting (PEW) is a common medical phenomenon that is observed in maintenance dialysis patients. PEW also increases morbidity and mortality of these patients. Its pathogenesis is unclear. We hypothesize that serum irisin levels and volume overload may induce PEW in peritoneal dialysis (PD) patients. The aim of this study is to measure serum irisin levels, evaluate volume status of PD patients, and study their correlations with PEW in PD patients. Methods: This study is a cross-sectional study with 160 PD patients from the PD center of Peking University Third Hospital and 35 healthy control subjects. PD patients were divided into PEW group and non-PEW group according to PEW diagnosis criteria. Serum irisin concentrations were measured by ELISA. Volume overload status (volume overload is defined as overhydration value ≥2 liters) of PD patients was analyzed by bioelectrical impedance. Results: The serum irisin levels were significantly lower in PD patients compared with those of the controls (113.2±11.8 ng/ml vs. 464.2±37.4 ng/ml, P<0.01). The serum irisin levels were lower in PD patients with PEW than those of the patients without PEW (106.5±15.2 ng/ml vs. 117.4±17.6 ng/ml, P<0.01). PEW is more prevalent in patients with volume overload than patients without volume overload (62.5% vs. 43.1%, x 2 =5.756, P=0.016); however, no direct relationship was found between irisin levels and volume overload status. The independent influencing factors of PEW were serum irisin, serum albumin, and volume overload. Conclusion: Our results are the first to provide clinical evidence of the association between serum irisin, volume overload, and PEW in PD patients. PEW may inhibit the release or synthesis of irisin from skeletal muscles, and volume overload may aggravate PEW in PD patients.

Anemia, overhydration, and lower muscle strength in hemodialysis patients with protein‐energy wasting

“…25 The association between PEW and overhydration has been previously described in PD patients. 26,27 In this study, the volume status of patients with PEW was strongly associated with overhydration according to bioimpedance results, despite not being apparent on physical examination. It has been postulated that HD patients have changes in the distribution of fluid volume between corporal compartments.…”

Relationship between Serum Irisin Level, All-Cause Mortality, and Cardiovascular Mortality in Peritoneal Dialysis Patients

“…baseline. All the discrepancies contributed to the higher CV mortality in the low irisin In addition, high serum irisin levels always represent a high muscle mass and well nutrition status [16]. The association between sarcopenia and the poor prognosis in PD patients [17] can partially explain the correlation between low serum irisin levels and increased mortality.…”

“…In diabetic cardiomyopathy mice, low-dose irisin treatment alleviated cardiac fibrosis by inhibiting endothelial-to-mesenchymal transition, while high-dose irisin led to cardiac fibrosis by enhancing matrix metalloproteinases [15]. Our previous study showed that serum irisin concentrations of PD patients were significantly lower than those of healthy controls [16]. Hence, the relatively low serum irisin levels may exert a protective effect on the CV outcomes of incident PD patients.…”

Development and validation of a nomogram to predict protein-energy wasting in patients with peritoneal dialysis: a multicenter cohort study

“…PD Patients with PEW develop a disequilibrium between energy intake and expenditure ( Kittiskulnam et al, 2021 ; Tennankore & Bargman, 2013 ). According to the criteria of the International Society of Renal Nutrition and Metabolism (ISRNM), previous investigations reported PEW ranged between 14.1% and 83% in patients with peritoneal dialysis ( Liu et al, 2015 ; Markaki et al, 2016 ; Harvinder et al, 2016 ; Zhou et al, 2017 ). PEW leads to lower quality of life and a higher hospitalization rate, morbidity, and mortality ( Velasquez et al, 2013 ; Yasui et al, 2016 ; Chao et al, 2017 ).…”