Korucu Berfu, Erten Yasemin T, Yeter Haci H, Altinova Alev, Pasaoglu Ozge T, Pasaoglu Hatice, Sindel Mahmut S, Arinsoy Selim T, Yetkin Ilhan
Department of Nephrology, Gazi University Faculty of Medicine, Ankara, Turkey.
Department of Endocrinology, Gazi University Faculty of Medicine, Ankara, Turkey.
Ther Apher Dial. 2019 Oct;23(5):437-443. doi: 10.1111/1744-9987.12798. Epub 2019 Mar 21.
Loss of appetite affects one-third of patients with CKD and is the leading cause of malnutrition in this population. Orexigenic Agouti-related peptide (AgRP) with neuropeptide-Y (NPY) and anorexigenic melanocyte-stimulating hormone-α (MSH-α) with cocaine- and amphetamine-regulated transcript (CART) are known to regulate appetite. In this study, we aimed to evaluate the levels of these peptides in CKD patients compared to healthy subjects and demonstrate the effects of dialysis treatment and erythropoiesis-stimulating agent (ESA) therapy. The cross-sectional study is composed of consecutive inclusion of 20 healthy individuals, 20 predialysis CKD patients, 20 HD, and 20 peritoneal dialysis (PD) patients. Exclusion criteria were an active infection, history of malignancy, hypo- or hyperthyroidism, and diabetes. Patients on dialysis had targeted Kt/Vs. Demographic features and BMIs of the four groups were similar. Levels of AgRP, NPY, AMSH, and CART were significantly different between groups. Nondialysis CKD patients had significantly lower hypothalamic hormones compared to healthy individuals, HD and PD patients (P = 0.02, P = 0.03, and P = 0.07 for AgRP; P = 0.02, P = 0.01, and P = 0.09 for NPY; P = 0.02, P = 0.02, and P = 0.03 for AMSH; P = 0.02, P = 0.005, and P = 0.030 for CART). Dialysis patients with or without ESA treatment had similar hormone levels (P = 0.13 for AgRP; P = 0.11 for NPY; P = 0.23 for AMSH, and P = 019 for CART). Predialysis CKD patients have lower orexigenic and presumably indirectly lower anorexigenic peptides compared to healthy subjects and dialysis patients. ESA treatment does not affect these hypothalamic peptides in dialysis patients.
食欲不振影响三分之一的慢性肾脏病患者，是该人群营养不良的主要原因。已知具有神经肽Y（NPY）的促食欲刺鼠相关肽（AgRP）和具有可卡因和苯丙胺调节转录物（CART）的促黑素细胞激素-α（MSH-α）调节食欲。在本研究中，我们旨在评估慢性肾脏病患者与健康受试者相比这些肽的水平，并证明透析治疗和促红细胞生成素（ESA）治疗的效果。这项横断面研究连续纳入了20名健康个体、20名透析前慢性肾脏病患者、20名血液透析患者和20名腹膜透析患者。排除标准为活动性感染、恶性肿瘤病史、甲状腺功能减退或亢进以及糖尿病。透析患者有目标Kt/V值。四组的人口统计学特征和体重指数相似。各组之间AgRP、NPY、AMSH和CART的水平有显著差异。与健康个体、血液透析和腹膜透析患者相比，未透析的慢性肾脏病患者下丘脑激素水平显著降低（AgRP分别为P = 0.02、P = 0.03和P = 0.07；NPY分别为P = 0.02、P = 0.01和P = 0.09；AMSH分别为P = 0.02、P = 0.02和P = 0.03；CART分别为P = 0.02、P = 0.005和P = 0.030）。接受或未接受ESA治疗的透析患者激素水平相似（AgRP为P = 0.13；NPY为P = 0.11；AMSH为P = 0.23，CART为P = 0.19）。与健康受试者和透析患者相比，透析前慢性肾脏病患者的促食欲肽水平较低，推测间接导致促食欲肽水平也较低。ESA治疗对透析患者的这些下丘脑肽没有影响。
