title: Association of plasma des-acyl ghrelin levels with CKD.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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-α, 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-α, 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-α, 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.
authors.affiliation: Division of Nephrology, Department of Medicine, University of Virginia Health Sciences Center, Charlottesville, Virginia 22908, USA.
authors.forename: Rohit K
authors.initials: RK
authors.lastname: Gupta
authors.forename: Tamil
authors.initials: T
authors.lastname: Kuppusamy
authors.forename: James T
authors.initials: JT
authors.lastname: Patrie
authors.forename: Bruce
authors.initials: B
authors.lastname: Gaylinn
authors.forename: Jianhua
authors.initials: J
authors.lastname: Liu
authors.forename: Michael O
authors.initials: MO
authors.lastname: Thorner
authors.forename: Warren K
authors.initials: WK
authors.lastname: Bolton
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D005260:Female; D054439:Ghrelin / Q000097:blood*; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood; D007668:Kidney / Q000378:metabolism / Q000503:physiopathology; D007676:Kidney Failure, Chronic / Q000097:blood; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D019518:Postprandial Period; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000097:blood* / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D012720:Severity of Illness Index; D013997:Time Factors
chemical_list: D015415:Biomarkers; D054439:Ghrelin; D018836:Inflammation Mediators; C422650:ghrelin, des-n-octanoyl