Severity of Gastric Mucosal Atrophy Is the Major Determinant of Plasma Ghrelin Level in Hemodialysis Patients

Abstract

Background: Ghrelin, an orexigenic hormone, has multiple favorable functions including protein anabolism enhancement, anti-inflammatory actions, and cardiovascular protection. A low plasma ghrelin level is associated with increased mortality in patients treated with hemodialysis (HD). However, it is unclear whether the plasma ghrelin level in HD patients correlates with the severity of gastric mucosal atrophy and Helicobacter pylori status. Methods: Seventy-eight maintenance HD patients and 51 non-dialysis patients with chronic kidney disease were evaluated for severity of gastric mucosal atrophy by gastroduodenoscopy and for H. pylori status using an anti-H. pylori-antibody and rapid urease test. Plasma acyl and des-acyl ghrelin levels were measured and their associations with relevant clinical parameters were investigated. Results: Des-acyl ghrelin level in HD patients was significantly higher than that in patients with kidney function preserved. Although acyl and des-acyl ghrelin levels were similar between current H. pylori positive and negative HD patients, both levels decreased significantly with the progress of endoscopic gastric mucosal atrophy in HD patients. Serum pepsinogen (PG) I level and PG I/II ratio decreased significantly according to the severity of atrophy in HD patients and positively significantly correlated with both ghrelin levels. Multiple regression analysis showed significant positive correlations between acyl ghrelin and PG I levels (β = 0.738, p < 0.001) and significant negative correlations between ghrelin and age, albumin, and creatinine levels. Conclusions: Gastric atrophy is the major determinant of ghrelin level in HD patients. Management practices, such as H. pylori eradication, before advanced atrophy may be required to prevent the decrease of ghrelin levels and improve the prognosis of HD patients.

Natural Course of <b><i>Helicobacter pylori</i></b> Infection in Japanese Hemodialysis Patients

“…Therefore, serum PG ratio may be a biomarker for H. pylori infection status and gastric atrophy in dialysis patients. We previously reported a significant positive correlation between PG and ghrelin levels in hemodialysis patients, suggesting that serum PG level and PG l/II ratio might be useful determinations of nutrition status, such as protein energy wasting [38,39]. Thus, further large-scale studies are needed to verify whether serum PG level or ratio represents a parameter of H. pylori infection status, serological severity of serological gastric atrophy, and nutrition status in hemodialysis patients to validate this new finding.…”

Relationship between ghrelin,Helicobacter pyloriand gastric mucosal atrophy in hemodialysis patients

“…After written informed consent was obtained, all hemodialysis patients and control subjects underwent gastroduodenoscopy and blood samples were taken for measurement of plasma ghrelin level on a non-dialysis day. Of 108 hemodialysis patients, 78 patients who received regular hemodialysis at Hamana clinic (Hamamatsu, Japan) was used in previous report which investigated associations with plasma grhrelin level and gastric mucosal atoprophy as single center study[19]. In this study, because previous our study could not show significant association with grhrelin level and present H. pylori infection (present infection and present non-infection including of non-infection and past infection), we focused in associations with plasma grhrelin level and infection status of H. pylori (non-infection, past infection and present infection) and we did as multicenter trial.…”

“…We also thank Nephrologists enrolled patients in this study (Hisanori Azekura, Sanaru Sun-Clinic; Koji Sano, Sano Clinic; Fuyuki Yamashita, Yamashita Clinic; Shigeru Tadokoro, Tadokoro Clinic; Ken Fukuta, Hiryu Clinic; Asahi Shimomura, Sanarudai Asahi-Clinic; Kunihiro Hayakawa, Satsuki no Mori Clinic). Of 108 hemodialysis patients, 78 patients who received regular hemodialysis at Hamana Clinic (Hamamatsu, Japan) were used in previous report[19]. …”

Efficacy of Reduced Dosage of Amoxicillin in an Eradication Therapy for Helicobacter pylori Infection in Patients on Hemodialysis: A Randomized Controlled Trial

“…Therefore, it is required to plan a strategy as to how to prevent development of diseases in hemodialysis patients. In addition, the level of ghrelin, which is controlling the nutrition situation and appetite, is often low in hemodialysis patients compared with that in healthy controls [9, 10], and administration of ghrelin improves malnutrition via increase of appetite [11, 12]. In general, ghrelin level is downregulated by continuous H. pylori infection, and is upregulated by eradication therapy [13-15].…”