title: Higher total ghrelin levels are associated with higher insulin-mediated glucose disposal in non-diabetic maintenance hemodialysis patients.
abstract: OBJECTIVE
  Insulin resistance is common in maintenance hemodialysis (MHD) and it can contribute to exceedingly high mortality in MHD patients. Ghrelin is a gastric hormone whose total plasma concentration is increased in MHD. Emerging data suggest a potential role of ghrelin to modulate intermediate metabolism but the metabolic impact of ghrelin in chronic kidney disease is unknown. The current study aimed at assessing the potential relationships between ghrelin and insulin sensitivity in MHD.
  
  
  METHODS
  Total (T-Ghr) and acylated (A-Ghr) ghrelin as well as insulin-mediated glucose disposal [(M): hyperinsulinemic-euglycemic clamp] were measured in non-diabetic non-obese ambulatory MHD patients (n=19, 16 Males). C-reactive protein (CRP) was also measured since systemic inflammation is associated with insulin resistance in non-renal patients and inflammation is negatively modulated by ghrelin in experimental models.
  
  
  RESULTS
  Compared to control subjects (C: n=9, 7 Males), MHD had similar body fat and resting energy expenditure but reduced M and increased CRP (P<0.05). MHD also had higher T-(P<0.05) but not A-Ghr. M was associated positively with T-Ghr and negatively with CRP in linear regression analysis in MHD. In stepwise multiple regression analysis only T-Ghr remained associated with M (P<0.05) in a model including A-Ghr and CRP.
  
  
  CONCLUSIONS
  Insulin sensitivity is associated negatively with systemic inflammation and positively with total plasma ghrelin in non-diabetic MHD patients. Based on available knowledge these results suggest a potential novel role of ghrelin in preserving insulin sensitivity in MHD.
authors.affiliation: Clinica Medica-Department of Clinical, Morphological and Technological Sciences (DSCMT), Italy. barazzon@units.it
authors.forename: Rocco
authors.initials: R
authors.lastname: Barazzoni
authors.forename: Michela
authors.initials: M
authors.lastname: Zanetti
authors.forename: Manuela
authors.initials: M
authors.lastname: Stulle
authors.forename: Maria Pia
authors.initials: MP
authors.lastname: Mucci
authors.forename: Alessia
authors.initials: A
authors.lastname: Pirulli
authors.forename: Franca
authors.initials: F
authors.lastname: Dore
authors.forename: Giovanni
authors.initials: G
authors.lastname: Panzetta
authors.forename: Alfonso
authors.initials: A
authors.lastname: Vasile
authors.forename: Gianni
authors.initials: G
authors.lastname: Biolo
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Guarnieri
mesh_terms: D000328:Adult; D000368:Aged; D001481:Basal Metabolism / Q000502:physiology; D001786:Blood Glucose / Q000378:metabolism*; D002097:C-Reactive Protein / Q000378:metabolism; D016022:Case-Control Studies; D005260:Female; D054439:Ghrelin / Q000097:blood*; D015309:Glucose Clamp Technique; D006801:Humans; D007328:Insulin / Q000097:blood*; D007333:Insulin Resistance; D007676:Kidney Failure, Chronic / Q000097:blood / Q000378:metabolism*; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis
chemical_list: D001786:Blood Glucose; D054439:Ghrelin; D007328:Insulin; D002097:C-Reactive Protein