Association of plasma dys-acyl ghrelin with different stages of chronic kidney disease

HU Zhijuan; WANG Lijun; SHI Yanan; GAO Zhanhong; NIU Kai; LIU Bing

doi:10.3969/j.issn.1006-5725.2017.13.019

Abstract：Objectives To assess the plasma levels of acyl ghrelin (AG) and dys-acyl ghrelin (DG) in chronic kidney disease (CKD) and hemodialysis (HD) patients and analyze their relationships with different stages of CKD and hemodialysis. Methods Forty-six CKD stage 1-5 patients and 15 hemodialysis patients were enrolled into the study. Body weight, height, hemoglobin, biochemical parameters, inflammatory parameters, preprandial, postprandial and 3 hours after hemodialysis plasma AG and DG levels were measured. Appetite and food intake were assessed. Body mass index (BMI), and estimated glomerular filtration rate (eGFR) were calculated. Results There were no significant differences in BMI, SGA, appetite, food intake and malnutrition among CKD patients of different stages. eGFR was declining with the progression of CKD stages and patients received a three-week hemodi-alysis. Compared with that in CKD stage 1-2 patients, the level of preprandial and postprandial DG was remarkably increased in stage 3-5 patients (P<0.01). The level of DG was significantly decreased after a standard breakfast in CKD patients (P<0.01). CKD stage was positively correlated with preprandial (r=0.31, P<0.05)a nd postprandi-al DG (r=0.34, P < 0.05), TNF-α (r=0.33, P < 0.05), IL-6 (r=0.40, P < 0.05), leptin (r=0.34, P < 0.05), and age (r=0.41, P<0.05). CKD stage was also highly and positively correlated with the proportion of preprandial and postprandial DG (r=0.61, P<0.01;r=0.55, P<0.01). Multivariate partial-correlation analysis showed that CKD was independently associated with the proportion of preprandial and postprandial DG (r=0.55, P < 0.01; r=0.43, P < 0.01).There was no decrease in AG postprandially, nor any changes in AG resultant from dialysis (P > 0.05);levels of DG decreased slightly postprandially and were markedly decreased by hemodialysis (P<0.01), even lower than those seen postprandially in CKD stage 1-2;Both preprandial and postprandial DG were negatively correlated with serum albumin levels (r=-0.64, P < 0.05; r=-0.59, P < 0.05), while there was no correlation between AG and serum albumin levels. Conclusions There is a strong and independent correlation of DG with CKD stage. Postprandial suppression of ghrelin is impaired with reduced renal function. Hemodialysis removes DG but not AG.