Document Detail


Protein-energy wasting modifies the association of ghrelin with inflammation, leptin, and mortality in hemodialysis patients.
MedLine Citation:
PMID:  21178976     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Ghrelin abnormalities contribute to anorexia, inflammation, and cardiovascular risk in hemodialysis patients, leading to worse outcome. However, ghrelin levels are influenced by the nutritional status of the individual. We hypothesized that the consequences of ghrelin alterations in hemodialysis patients are context sensitive and dependent on the presence of protein-energy wasting (PEW). In this cross-sectional study of 217 prevalent hemodialysis patients followed for 31 months, we measured ghrelin, leptin, PEW (subjective global assessment), and C-reactive protein (an index of inflammation). Compared to patients in the middle and upper tertile of ghrelin levels, those in the lowest tertile were older, had higher leptin levels and body mass index, and presented an increased mortality risk that persisted after adjustment for age, gender, and dialysis vintage. This risk was lost after correction for comorbidities. Patients with PEW and low ghrelin values had abnormally high C-reactive protein and leptin by multivariate analysis of variance, and the highest mortality risk compared to non-PEW with high ghrelin from all-cause and cardiovascular-related mortality (adjusted hazard ratios of 3.34 and 3.54, respectively). Low ghrelin values in protein-energy wasted hemodialysis patients were linked to a markedly increased cardiovascular mortality risk. Thus, since these patients were more anorectic, our results provide a clinical scenario where ghrelin therapies may be particularly useful.
Authors:
Juan J Carrero; Ayumu Nakashima; Abdul R Qureshi; Bengt Lindholm; Olof Heimbürger; Peter Bárány; Peter Stenvinkel
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2010-12-22
Journal Detail:
Title:  Kidney international     Volume:  79     ISSN:  1523-1755     ISO Abbreviation:  Kidney Int.     Publication Date:  2011 Apr 
Date Detail:
Created Date:  2011-03-15     Completed Date:  2011-07-07     Revised Date:  2011-11-03    
Medline Journal Info:
Nlm Unique ID:  0323470     Medline TA:  Kidney Int     Country:  United States    
Other Details:
Languages:  eng     Pagination:  749-56     Citation Subset:  IM    
Affiliation:
Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
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MeSH Terms
Descriptor/Qualifier:
Aged
Biological Markers / blood
Body Mass Index
C-Reactive Protein / analysis
Cardiovascular Diseases / blood,  immunology,  mortality*
Chi-Square Distribution
Cross-Sectional Studies
Female
Ghrelin / blood*
Humans
Inflammation / blood,  immunology,  mortality*
Kaplan-Meier Estimate
Kidney Failure, Chronic / blood,  immunology,  mortality*,  therapy*
Leptin / blood*
Male
Middle Aged
Proportional Hazards Models
Protein-Energy Malnutrition / blood,  immunology,  mortality*
Renal Dialysis / mortality*
Risk Assessment
Risk Factors
Sweden
Time Factors
Chemical
Reg. No./Substance:
0/Biological Markers; 0/GHRL protein, human; 0/Ghrelin; 0/Leptin; 9007-41-4/C-Reactive Protein
Comments/Corrections
Comment In:
Kidney Int. 2011 Oct;80(7):783; author reply 783-4   [PMID:  21918561 ]
Kidney Int. 2011 Oct;80(8):894; author reply 894   [PMID:  21960171 ]
Kidney Int. 2011 Apr;79(7):697-9   [PMID:  21403653 ]
Nat Rev Nephrol. 2011 Mar;7(3):124   [PMID:  21473009 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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