Study of Endogenous Plasma Ghrelin KInetics in End Stage renal Disease Patients on Maintenance Dialysis

• Main Authors: Chia-Chu Chang, 張家築
• Other Authors: CHING-YUANG LIN
• Format: Others
• Language: zh-TW
• Published: 2005
• Online Access: http://ndltd.ncl.edu.tw/handle/34594524150515834391

碩士 === 長榮大學 === 醫學研究所碩士班醫學組 === 93 === Appetite suppression in end-stage renal disease (ESRD) causes malnutrition and serious morbidity. There are many peripheral signals, both short–term and long-term, that can greatly contribute to feeding behavior. Endogenous ghrelin has also cardiovascular effects. Here, we investigated the endogenous ghrelin metabolism in dialysis patients and the correlation between plasma ghrelin levels and appetite, nutritional markers, blood pressure, and cardiovascular function functions. At first, we measured plasma ghrelin levels at 2-h intervals during a 24 hours period in 22 non-diabetic (non-DM) hemodialysis (HD) patients, separated into normal intake or disturbed intake via subjective global assessment (SGA) estimation. Furthermore, 50 continuous ambulatory peritoneal dialysis (CAPD) patients were enrolled that subject’s blood was drawn in the morning and 2 hours postprandially to radioimmunoassay fasting and postprandial plasma ghrelin levels. They all completed our appetite survey, consisting of subjective global assessment (SGA) questionnaires and visual analog scales (VAS) measurement, before and after eating, of 4 variables (hunger, desire, sense of fullness, prospective consumption). We found that significant positive correlation existed between plasma ghrelin 24-h AUC profile and most time-specific plasma ghrelin levels in non-DM HD patients. Average plasma ghrelin clearance of single hemodialysis was about 53%. Mean AUC ghrelin level in the abnormal intake group was higher than in the normal intake group. In CAPD subjects, no significant correlation was shown between serum ghrelin levels and the four VAS variables. Plasma ghrelin levels were inversely correlated with peritoneal/plasma (D/Pghrelin) clearance ratio (was between 0.5 and 0.8 respectively). and the correlation became more obvious as dwelling time increased. There was positive correlation between ghrelin mass transfer amounts in 24 hours and D/PCr ratio. Among AUC ghrelin and left ventricle (LV) functions including left ventricle mass index (LVMI), left ventricle mass (LVM) and interventricular septum distance (IVSd) had significantly positive correlation. Inverse correlation existed between ghrelin and right ventricular dimension (RVD). Plasma ghrelin concentrations had significant positive correlation with myocardium growth (LVM, LVMI, IVSd and LPVWD) in CAPD subjects. Body mass index (BMI) and fat content also had significant negative correlation with plasma ghrelin levels in both study groups. In conclusions, anorexia instead of hyperphagia was found in patients with higher plasma AUC ghrelin levels. Plasma ghrelin levels, either AUC or time-specific, in ESRD ongoing dialysis patients showed significant correlation with left ventricular mass progression.