title: Ghrelin plasma levels and appetite in peritoneal dialysis patients.
abstract: Anorexia-associated malnutrition is a severe complication that increases mortality in peritoneal dialysis (PD) patients. Ghrelin is a recently-discovered orexigenic hormone with actions in brain and stomach. We analyzed, in 42 PD patients, the possible relationship between ghrelin and appetite regulation with regard to other orexigens [neuropeptide Y (NPY), NO3] and anorexigens [cholecystokinin (CCK), leptin, glucose-dependent insulinotropic peptide (GIP), tumor necrosis factor alpha (TNFalpha)]. All orexigens and anorexigens were determined in plasma. Eating motivation was evaluated using a visual analog scale (VAS). The patients were divided into three groups: those with anorexia (n = 12), those with obesity associated with high intake (n = 12), and those with no eating behavior disorders (n = 18). A control group of 10 healthy volunteers was also evaluated. Mean plasma levels of ghrelin were high (3618.6 +/- 1533 mg/mL), with 36 patients showing values above the normal range (< 2600 mg/mL). Patients with anorexia had lower ghrelin and NPY levels and higher peptide-C, CCK, interleukin-1 (IL-1), TNFalpha, and GIP levels than did the other patients. Patients with anorexia also had an early satiety score and low desire and pleasure in eating on the VAS and diet survey. We observed significant positive linear correlations between ghrelin and albumin (r = 0.43, p < 0.05), prealbumin (r = 0.51, p < 0.05), transferrin (r = 0.4, p < 0.05), growth hormone (r = 0.66, p < 0.01), NO3 (r = 0.36, p < 0.05), and eating motivation (VAS). At the same time, negative relationships were observed between blood ghrelin and GIP (r = -0.42, p < 0.05), insulin (r = -0.4, p < 0.05), leptin (r = -0.45, p < 0.05), and creatinine clearance [r = -0.33, p = 0.08 (nonsignificant)]. Ghrelin levels were not related to Kt/V or to levels of CCK and cytokines. Ghrelin plasma levels are elevated in PD patients. Uremic patients with anorexia show relatively lower ghrelin plasma levels than the levels seen in obese patients or in patients with normal appetite. The role of ghrelin in appetite modulation is altered in uremic PD patients, and that alteration is possibly associated with disorders in insulin and growth hormone metabolism.
authors.affiliation: Nephrology Services, University Hospitals La Princesa and La Paz, Instituto de Investigación Nefrológica Reina Sofía, Madrid, Spain. aguileraa@terra.es
authors.forename: Abelardo
authors.initials: A
authors.lastname: Aguilera
authors.forename: Antonio
authors.initials: A
authors.lastname: Cirugeda
authors.forename: Ruth
authors.initials: R
authors.lastname: Amair
authors.forename: Gabriela
authors.initials: G
authors.lastname: Sansone
authors.forename: Laura
authors.initials: L
authors.lastname: Alegre
authors.forename: Rosa
authors.initials: R
authors.lastname: Codoceo
authors.forename: M Auxiliadora
authors.initials: MA
authors.lastname: Bajo
authors.forename: Gloria
authors.initials: G
authors.lastname: del Peso
authors.forename: Juan J
authors.initials: JJ
authors.lastname: Díez
authors.forename: José A
authors.initials: JA
authors.lastname: Sánchez-Tomero
authors.forename: Rafael
authors.initials: R
authors.lastname: Selgas
mesh_terms: D000328:Adult; D000368:Aged; D000855:Anorexia / Q000097:blood* / Q000503:physiopathology; D001069:Appetite Regulation / Q000502:physiology; D001798:Blood Proteins / Q000032:analysis; D002766:Cholecystokinin / Q000097:blood / Q000502:physiology; D016207:Cytokines / Q000097:blood / Q000502:physiology; D004435:Eating; D005260:Female; D005749:Gastric Inhibitory Polypeptide / Q000097:blood / Q000502:physiology; D054439:Ghrelin; D006801:Humans; D020738:Leptin / Q000097:blood / Q000502:physiology; D008297:Male; D008875:Middle Aged; D009478:Neuropeptide Y / Q000097:blood / Q000502:physiology; D009569:Nitric Oxide / Q000097:blood; D009752:Nutritional Status; D009765:Obesity / Q000097:blood; D036361:Peptide Hormones / Q000097:blood* / Q000502:physiology; D010530:Peritoneal Dialysis / Q000009:adverse effects
chemical_list: D001798:Blood Proteins; D016207:Cytokines; D054439:Ghrelin; D020738:Leptin; D009478:Neuropeptide Y; D036361:Peptide Hormones; D009569:Nitric Oxide; D005749:Gastric Inhibitory Polypeptide; D002766:Cholecystokinin