Plasma Gherlin And Leptin Levels In Patients Undergoing Maintenance Hemodialysis

ObjectiveThe aim of study is to investigate the fasting plasma total ghrelin and leptin levels in hemodialysis patients. The factors that affect their plasma levels are also explored. We like to reveal whether their levels are abnormal in these patients with anorexia, malnutrition, micro-inflammation, insulin resistance related metabolic syndrome. We want further to understand their regulatory role in these patients and open up new areas for the treatment of these patients related complications.MethodsThe levels of fasting total ghrelin and leptin were measured by ELISA in 30 hemodialysis patients and 15 normal controls. We also measured the medical examination and blood biochemical markers about nutritional status﹑micro-inflammation﹑metabolic syndrome in dialysis patients. The nutritional and appetite status of dialysis patients were assessed by the modified quantitative subjective gloval assessment(SGA) nutrition and subjective appetite questionnaire. We compared the plasma total ghrelin﹑leptin levels and their ratio between dialysis and control group, normal appetite dialysis groups A and groups B with anorexia, body mass index (BIM)<20 dialysis groups and BIM>20 groups, nutrition normal dialysis groups and the malnourished groups. We also explored the correlations between the plasma total ghrelin﹑leptin levels,their ratio and age, selected nutritional﹑inflammation﹑metabolic syndrome markers respectively.ResultsThe fasting plasma toal ghrelin levels and the ratio betwee plasmsa ghrelin and leptin levels in dialysis groups were higher than that in controls.However,there was no difference in the fasting plasma leptin levels between them. In the dialysis groups, the fasting plasma leptin levels were significantly higher in the normal appetite group A than that in the anorexia group B, while the total plasma ghrelin levels lower than the anorexia group B.There were no significant differences in the fasting plasma toal ghrelin﹑leptin levels and their ratio between the BIM<20 and>20 groups, the normal nutrition and unnutrition groups(by SGA) respectively in dialysis groups. The fasting plasma leptin levels was positively correlated with body weigh﹑triceps skinfold(TSF),and negatively with midarm muscle circumference(MAC)﹑calf circumference in dialysis patients. The ghrelin-leptin ratio was positively correlated with serum C-reactive protein(CRP)﹑the modified quantitative SGA score, while negatively with serum albumin﹑TSF. The fasting plasma levels of toal ghrelin﹑serum albumin was negative correlation with age respectively, while CRP﹑the ghrelin-leptin ratio positive correlation with age. The negative relationship between serum albumin and CRP was found in dialysis groups.ConclusionsThe fasting plasma ghrelin levels and the ratio betwee plasmsa ghrelin and leptin levels are higher in hemodialysis(HD) patients. The abnormal secretion of ghrelin and leptin are associate with anorexia﹑malnutrition micro-inflammation in HD patients. Ghrelin secretion may increase under the regulatory effect of negative feedback in the event of anorexia, malnutrition, micro-inflammatory, while leptin reduce. Further to define the mechanism of abnormal secretion of ghrelin﹑leptin in HD patients will give a new direction of solving malnutrition- Inflammation- Atherosclerosis(MIA) Syndrome problem. Ghrelin inadequate secretion in senile patients with inadequate compensation may be one of the factors cause them prone to anorexia, malnutrition, micro-inflammatory. Ghrelin may be a new promising way as a new drug.to treat HD patients with anorexia, malnutrition, cardiovascular disease.