Koyuncu Sümeyra, Sipahioglu Hilal, Uysal Cihan, Karakukcu Cigdem
Nephrology, Kayseri State Hospital, Kayseri, TUR.
Intensive Care Unit, Kayseri City Training and Research Hospital, Kayseri, TUR.
Cureus. 2023 May 2;15(5):e38441. doi: 10.7759/cureus.38441. eCollection 2023 May.
Background Peritoneal dialysis patients are malnourished due to loss of protein in the dialysate and inadequate dialysis, although they take additional calories every day during treatment. Many parameters are used to assess nutritional status, with normalized protein catabolic rate (nPCR) being one of the most common. Asprosin, a novel adipokine secreted by adipose tissue, peaks during fasting and induces hepatic glucose release through the activation of the G-protein-cAMP-PKA pathway, which has been indicated to have a curative effect on chronic inflammation. In this study, we aimed to investigate the relationship between asprosin levels and nutritional parameters in patients receiving peritoneal dialysis treatment as well as to investigate the applicability of more practical tests. Methodology A total of 70 peritoneal dialysis patients, 35 female (59%) and 24 male (41%), were included in the study. The mean age of the patients was 53 ± 14 years (range = 18-80 years), and the median peritoneal dialysis duration was 31.5 months (range = 20-56.2 months). The most common etiologic cause was hypertension (37%). Patients over 18 years of age who had been receiving peritoneal dialysis treatment for at least 24 months were included in the study. The correlation between patients' nPCR levels and serum asprosin, body mass index, and lipids was evaluated. Results The correlation between the level of nPCR and the serum asprosin level, body mass index, and lipids was evaluated. Patients with nPCR <0.815 were considered malnourished, and factors affecting malnutrition were determined by univariate analysis. Among the factors affecting malnutrition according to univariate analysis, those with p-value <0.05 were analyzed by multivariate analysis. Low asprosin level was one of the independent factors affecting malnutrition in patients (Exp(B) = 0.944, 95% confidence interval (CI) = 0.896-0.994). Other independent factors affecting malnutrition were Kt/V (Exp(B) = 0.018, 95% CI = 0.001-0.550) and residual renal function (Exp(B) = -0.004, 95% CI = 0.993-0.999). Conclusions There is a need for more accessible tests and reliable parameters to evaluate dialysis and nutritional deficiency in peritoneal dialysis patients. One possible hormone that could serve as a guide is asprosin.
背景 尽管腹膜透析患者在治疗期间每天摄入额外的热量，但由于透析液中蛋白质的流失和透析不充分，他们仍会出现营养不良。许多参数用于评估营养状况，其中标准化蛋白分解代谢率（nPCR）是最常用的参数之一。Asprosin是一种由脂肪组织分泌的新型脂肪因子，在禁食期间达到峰值，并通过激活G蛋白 - cAMP - PKA途径诱导肝脏释放葡萄糖，该途径已被证明对慢性炎症有治疗作用。在本研究中，我们旨在探讨接受腹膜透析治疗的患者中Asprosin水平与营养参数之间的关系，并研究更实用检测方法的适用性。
方法 本研究共纳入70例腹膜透析患者，其中女性35例（59%），男性24例（41%）。患者的平均年龄为53±14岁（范围 = 18 - 80岁），腹膜透析的中位持续时间为31.5个月（范围 = 20 - 56.2个月）。最常见的病因是高血压（37%）。纳入研究的患者为年龄超过18岁且接受腹膜透析治疗至少24个月的患者。评估了患者的nPCR水平与血清Asprosin、体重指数和血脂之间的相关性。
结果 评估了nPCR水平与血清Asprosin水平、体重指数和血脂之间的相关性。nPCR<0.815的患者被认为营养不良，并通过单因素分析确定影响营养不良的因素。在单因素分析中影响营养不良的因素中，p值<0.05的因素通过多因素分析进行分析。低Asprosin水平是影响患者营养不良的独立因素之一（Exp(B)=0.944，95%置信区间（CI）=0.896 - 0.994）。影响营养不良的其他独立因素是Kt/V（Exp(B)=0.018，95%CI = 0.001 - 0.550）和残余肾功能（Exp(B)= - 0.004，95%CI = 0.993 - 0.999）。
结论 需要更易于获取的检测方法和可靠的参数来评估腹膜透析患者的透析和营养缺乏情况。一种可能作为指导的激素是Asprosin。
