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Adiponectin and ghrelin: nutritional regulatory role in chronic kidney disease patients

The Egyptian Journal of Internal Medicine volume 31, pages 99–105 (2019)Cite this article

Abstract

Background

Adiponectin and ghrelin are orexigenic hormones involved in the regulation of appetite in kidney disease patients. The aim of the study is to investigate the plasma concentration of total adiponectin and ghrelin in hemodialysis (HD) patients, kidney transplant recipients (KTRs), and chronic kidney disease (CKD) patients not yet on regular dialysis.

Patients and methods

2The study included 180 patients with a mean age of 34.6±9.53 who were enrolled from the Nephrology Department of Cairo Medical School. Group 1 included 60 HD patients; group 2 included 60 KTRs. Group 3 included 60 participants with CKD not yet on dialysis. Anthropometric measures of all patients were taken. All participants were investigated for adiponectin, ghrelin, lipid profile, albumin, and hemoglobin. Adiponectin and ghrelin were correlated with variable parameters.

Results

One hundred and eight patients (60%) were men. Adiponectin was significantly higher in HD patients than KTRs and CKD groups (17±3.5, 10.8±5.2, and 4.7±2.3, respectively). Ghrelin was lower in KTRs compared with HD and CKD groups (2.1 ±0.2, 2.8±0.25, 2.8±0.3, respectively, P<0.001). Adiponectin and ghrelin were inversely correlated with BMI in all studied groups.

Conclusion

Adiponectin and ghrelin levels were highest in HD patients. Adiponectin was superior to ghrelin as a positive predictor of nutritional status in CKD.

References

  1. Alice S, Giuseppe R, Marco D, Tommaso DM, Chiara C, Sarah P, et al. Noninvasive evaluation of muscle mass by ultrasonography of quadriceps femoris muscle in end-stage renal disease patients on hemodialysis. Clin Nutr 2018; 19:S0261–5614.

    Google Scholar 

  2. Guebre-Egziabher F, Bernhard J, Geelen G, Malvoisin E, Hadj-Aissa A, Fouque D. Leptin, adiponectin, and ghrelin dysregulation in chronic kidney disease. J Ren Nutr 2005; 15:116–120.

    Article  PubMed  Google Scholar 

  3. Cummings DE, Overduin J. Gastrointestinal regulation of food intake. J Clin Invest 2007; 117:13–23.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Guebre-Egziabher F, Bernhard J, Funahashi T, Hadj-Aissa A, Fouque D. Adiponectin in chronic kidney disease is related more to metabolic disturbances than to decline in renal function. Nephrol Dial Transplant 2017; 20:129–134.

    Article  Google Scholar 

  5. Heidari M, Nasri P, Nasri H. Adiponectin and chronic kidney disease; a review on recent findings. J Nephropharmacol 2015; 4:63–68.

    CAS  PubMed  PubMed Central  Google Scholar 

  6. Jung UJ, Choi M-S. Obesity and its metabolic complications: the role of adipokines and the relationship between obesity, inflammation, insulin resistance, dyslipidemia and nonalcoholic fatty liver disease. Int J Mol Sci 2014; 15:6184–6223.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  7. Christou G, Kiortsis D. The role of adiponectin in renal physiology and development of albuminuria. J Endocrinol 2014; 221:R49–R61.

    Article  CAS  PubMed  Google Scholar 

  8. Rhee CM, Nguyen DV, Moradi H, Brunelli SM, Dukkipati R, Jing J, et al. Association of adiponectin with body composition and mortality in hemodialysis patients. Am J Kidney Dis 2015; 66:313–321.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Stengel A, Taché Y. Ghrelin – a pleiotropic hormone secreted from endocrine X/A-like cells of the stomach. Front Neurosci 2102; 6:1–15.

    Google Scholar 

  10. Mori K, Yoshimoto A, Takaya K, Hosoda K, Ariyasu H, Yahata K, et al. Kidney produces a novel acylated peptide, ghrelin. FEBS Lett 2000; 486:213–216.

    Article  CAS  PubMed  Google Scholar 

  11. Delporte C. Structure and physiological actions of ghrelin. Scientifica (Cairo) 2013; 2013:1–25.

    Article  CAS  Google Scholar 

  12. Gunta SS, Mak RH. Ghrelin and leptin pathophysiology in chronic kidney disease. Pediatr Nephrol 2013; 28:611–616.

    Article  PubMed  Google Scholar 

  13. Christine KA, Klöckener TC, Brüning J. Control of energy homeostasis by insulin and leptin: Targeting the arcuate nucleus and beyond. Physiol Behav 2009; 97:632–638.

    Article  CAS  Google Scholar 

  14. Chung S, Koh ES, Shin SJ, Park CW. Malnutrition in patients with chronic kidney disease. Open J Intern Med 2012; 02:89–99.

    Article  CAS  Google Scholar 

  15. Pupim LB, Cuppari L, Ikizler TA. Nutrition and metabolism in kidney disease. Semin Nephrol 2006; 26:134–157.

    Article  CAS  PubMed  Google Scholar 

  16. Levey A, Stevens L, Schmid C, Zhang Y, Castro A, Feldman H, et al. A new equation to estimate glomerular filtration rate. Ann Intern Med 2009; 150:604–612.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Kopple JD. McCollum. Award Lecture, 1996: protein-energy malnutrition in maintenance dialysis patients. Am J Clin Nutr 1997; 65:1544–1557.

    CAS  PubMed  Google Scholar 

  18. Anja KA, Rainer B, Stephan P, Berthold PH, Klause M, Peter FH. Ghrelin and other appetite-regulating hormones in paediatric patients with chronic renal failure during dialysis and following kidney transplantation. Nephrol Dial Transplant 2009; 24:643–646.

    Google Scholar 

  19. Ocak N, Dirican M, Ersoy A, Sarandol E. Adiponectin, leptin, nitric oxide, and C-reactive protein levels in kidney transplant recipients: comparison with the hemodialysis and chronic renal failure. Ren Fail 2016; 38:1639–1646.

    Article  CAS  PubMed  Google Scholar 

  20. Chan CM. Hyperlipidemia in chronic kidney disease. Ann Acad Med Singapore 2005; 35:31–35.

    Google Scholar 

  21. Suleiman B, El Imam M, Elsabigh M, Eltahir K, Eltahir A, Miskeen E. Lipid profile in post renal transplant patients treated with cyclosporine in Sudan. Saudi J Kidney Dis Transplant 2009; 20:312–317.

    Google Scholar 

  22. Razeghi E, Shafipour M, Ashraf H, Pourmand G. Lipid disturbances before and after renal transplant. Exp Clin Transplant 2011; 9:230–235.

    PubMed  Google Scholar 

  23. Chudek J, Adamczak M, Karkoszka H, Budzinski G, Ignacy W, Funahashi T, et al. Plasma adiponectin concentration before and after successful kidney transplantation. Transplant Proc 2003; 35:2186–2189.

    Article  CAS  PubMed  Google Scholar 

  24. Zoccali C, Mallamaci F, Panuccio V, Tripepi G, Cutrupi S, Parlongo S, et al. Adiponectin is markedly increased in patients with nephrotic syndrome and is related to metabolic risk factors. Kidney Int 2003; 63:S98–S102.

    Article  Google Scholar 

  25. Leibowitz A, Peleg E, Sharabi Y, Kamari Y. Normal adiponectin levels in kidney transplant patients with hypertension. Kidney Int 2013; 27:562–566.

    CAS  Google Scholar 

  26. Alam A, Molnar MZ, Czira ME, Rudas A, Ujszaszi A, Kalantar-Zadeh K, et al. Serum adiponectin levels and mortality after kidney transplantation. Clin J Am Soc Nephrol 2013; 8:460–467.

    Article  CAS  PubMed  Google Scholar 

  27. Nagy K, Nagaraju SP, Rhee CM, Mathe Z, Molnar MZ. Adipocytokines in renal transplant recipients. Clin Kidney J 2016; 9:359–373.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Caliskan Y, Yelken B, Gorgulu N, Ozkok A, Yazici H, Telci A, et al. Comparison of markers of appetite and inflammation between hemodialysis patients with and without failed renal transplants. J Ren Nutr 2012; 22:258–267.

    Article  CAS  PubMed  Google Scholar 

  29. Iglesias P, Díez JJ, Fernández-Reyes M, Codoceo R, Alvarez-Fidalgo P, Bajo MA, Aguilera A, Selgas R. Serum ghrelin concentrations in patients with chronic renal failure undergoing dialysis. Clin Endocrinol 2006; 64:68–73.

    Article  CAS  Google Scholar 

  30. Cnop M, Havel PJ, Utzschneider KM, Carr DB, Sinha MK, Boyko EJ, et al. Relationship of adiponectin to body fat distribution, insulin sensitivity and plasma lipoproteins: evidence for independent roles of age and sex. Diabetologia 2003; 46:459–469.

    Article  CAS  PubMed  Google Scholar 

  31. Ayala ER, Pecoits-Filho R, Heimbürger O, Lindholm B, Nordfors L, Stenvinkel P. Associations between plasma ghrelin levels and body composition in end-stage renal disease: a longitudinal study. Nephrol Dial Transplant 2004; 19:421–426.

    Article  Google Scholar 

  32. Elsayed N, Hamed S, El-Khatib M, El-shehaby A. The relation between dual energy x-ray absorptiometry measurement of body fat composition and plasma ghrelin in patients with end-stage renal disease. Saudi Med J 2009; 30:109–115.

    PubMed  Google Scholar 

  33. Genís BB, Granada ML, Alonso N, Lauzurica R, Jiménez JA, Barluenga E, et al. Ghrelin, glucose homeostasis, and carotid intima media thickness in kidney transplantation. Transplantation 2007; 84:1248–1254.

    Article  PubMed  CAS  Google Scholar 

  34. Monzani A, Perrone M, Prodam F, Moia S, Genoni G, Testa S, et al. Unacylated ghrelin and obestatin: promising biomarkers of protein energy wasting in children with chronic kidney disease. Pediatr Nephrol 2018; 33:661–672.

    Article  PubMed  Google Scholar 

  35. Muscaritoli M, Molfino A, Chiappini MG, Laviano A, Ammann T, Spinsanti P, et al. Anorexia in hemodialysis patients: the possible role of des-acyl ghrelin. Am J Nephrol 2007; 27:360–365.

    Article  CAS  PubMed  Google Scholar 

  36. Sedighi O, Abediankenari S. Relationship between plasma adiponectin level with inflammatory and metabolic markers in patients with chronic kidney disease. Nephrourol Mon 2014; 6:e11743.

    PubMed  Google Scholar 

  37. Stepien M, Stępień A, Wlazel R, Paradowski M, Banach M, Rysz M, et al. Obesity indices and adipokines in non-diabetic obese patients with early stages of chronic kidney disease. Med Sci Monit 2013; 19:1063–1072.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  38. Guenther M, James R, Marks J, Zhao S, Szabo A, Kidambi S. Adiposity distribution influences circulating adiponectin levels. Transl Res 2014; 164:270–277.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  39. Kamimura AM, Canziani FM, Sanches RF, Velludo MC, Carrero JJ, Bazanelli AP, et al. Variations in adiponectin levels in patients with chronic kidney disease: a prospective study of 12 months. J Bras Nefrol 2012; 34:259–265.

    Article  PubMed  Google Scholar 

  40. Ho KJ, Xue H, Mauro CR, Nguyen B, Yu P, Tao M, et al. Impact of uremia on human adipose tissue phenotype. J Surg Res 2013; 179:175–182.

    Article  PubMed  Google Scholar 

  41. Menon V, Li L, Wang X, Greene T, Balakrishnan V, Madero M, et al. Adiponectin and mortality in patients with chronic kidney disease. J Am Soc Nephrol 2006; 17:2599–2606.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Internal Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt

    Sahier O. El-Khashab & Mervat E. Behiry (MD Internal Medicine)

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  1. Sahier O. El-Khashab
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Correspondence to Mervat E. Behiry.

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El-Khashab, S.O., Behiry, M.E. Adiponectin and ghrelin: nutritional regulatory role in chronic kidney disease patients. Egypt J Intern Med 31, 99–105 (2019). https://doi.org/10.4103/ejim.ejim_78_18

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