The role of acyl-ghrelin in the pathogenesis of protein-energy wasting in patients with chronic kidney disease Stage 5D

THE AIM OF THE STUDY. To clarify the role of acyl-ghrelin in the development of protein-energy wasting of haemodialysis patients (HD).

PATIENTS AND METHODS. A total of 645 patients receiving treatment with programmatic bicarbonate HD for 8.4 ± 5.3 years, including 345 women and 300 men, the average age was 56.8 ± 12.8 years. Nutritional status was assessed using the method proposed by the International Society of Renal Nutrition and Metabolism (ISRNM). For the quantitative determination of acyl-ghrelin, the enzyme-linked immunosorbent assay kit “Active Ghrelin ELISA Kit” (highly sensitive method) from Sceti KK, Japan was used in this work. Reference values: 30 – 62 fmol/ml.

RESULTS. The prevalence of protein-energy wasting (PEM) using the ISRNM method was 24.9% (160 patients). Reduced levels of acyl-ghrelin were detected in 352 patients (54.5%). The average acyl-ghrelin values in patients without signs of PEW were 50.2±10.3 fmol/ml, and in patients with PEW 24.9±9.2 fmol/ml (p<0.0001). Patients with reduced acyl-ghrelin levels had statistically significantly lower values of total protein, albumin, prealbumin, total cholesterol, and transferrin than patients with normal acyl-ghrelin levels (p<0.0001, p<0.0001, p< 0.0001, p<0.001 and p<0.0001, respectively). Also, patients with reduced acyl-ghrelin levels were characterized by statistically significantly lower values of BMI, skeletal muscle mass, and percentage of body fat mass (p<0.001, p<0.001, p<0.001, respectively).

CONCLUSION. The prevalence of PEW in haemodialysis patients according to the ISRNM method was 24.9%. A reduced level of acyl-ghrelin in the blood serum may be an important pathogenetic link in the development of PEW in haemodialysis patients.

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