Nephrology Dialysis Transplantation, Vol 13, Issue 6 1476-1483, Copyright © 1998 by Oxford University Press
A Aguilera, R Codoceo, R Selgas, P Garcia, M Picornell, C Diaz, C Sanchez and M Bajo
Background: Malnutrition has definitely been related
to mortality among dialysis patients. Persistent loss of appetite is one of
the major symptoms found in these patients. It is also well recognized that
several substances produce anorexia or disorders of the hunger-satiety
cycle in several diseases. The aim of this study was to identify the role
of anorexigen substances (TNF-&agr; and cholecystokinin or CCK) and an
orexigen substance (Neuropeptide Y or NPY) in anorexia and malnutrition
among 55 clinically stable peritoneal dialysis (PD) patients.
Results: High TNF-&agr; plasma levels were found
in 41 of 42 patients (97.6%) with a mean of 70.5±32.3 pg/ml.
Patients with anorexia (n=11) or anorexia with nausea or vomiting (n=5) had
higher TNF-&agr; values than patients without these symptoms
75.9±34 vs 32.1±24.5 pg/ml, P<0.05). Eight
patients with a prior diagnosis of acid pylori disease showed higher
TNF-&agr; values (87.2±24.3) than 30 unaffected patients
(63.6±30.5, P<0.05). TNF-&agr; showed a significant
negative linear correlation with retinol binding protein (RBP) (r=-0.37,
n=34, P<0.05), and venous pH (r=-0.4, n=42, P<0.01); also,
TNF-&agr; values higher than 65 pg/ml were inversely associated with
transferrin, cholesterol, blood urea nitrogen (BUN) and CCK. Patients with
prealbumin levels lower than 30 mg/dl, a BMI lower than 30
kg/m2, nPCR lower than 1.1 g/kg/day and urea KT/V
lower than 2.2 showed higher serum TNF-&agr; levels. Patients who had
been on CAPD treatment for longer periods showed higher TNF-&agr;
values. High plasma CCK levels were found in 38 of 45 patients (84%), mean
45.9±32.3 pg/ml. Patients with anorexia had no difference in CCK
values compared with those without. A direct association was found between
CCK levels and some nutritional markers (albumin, fibronectin,
triglycerides, folic acid and nPCR in non diabetic patients). Although CCK
has a recognized anorectic effect, this direct association might be because
of an abnormal stimulation of CCK-glucose feedback (trypsin) due to
continuous peritoneal glucose absorption. This suggests that CCK could be
an immediate food intake marker in PD patients. The NPY plasma levels were
normal in 33 patients, high in 6 and low in 11. Patients with anorexia
showed lower NPY levels than those without. NPY values greater than 50
pg/ml were directly associated with higher transferrin, prealbumin, RBP,
nPCR and urea KT/V values. Importantly, a negative linear correlation
between NPY and TNF-&agr; was found (r=-0.42, n=41, P<0.01).
There was no significant relationship between residual renal clearance and
the serum levels of the three peptides. Conclusion: In
conclusion, our data suggest that high TNF-&agr; and low NPY serum
levels are associated with anorexia. High TNF-&agr; low CCK and low NPY
serum levels are also related to a poor nutritional status. Further
research on these circulating substances is required. Key
words: nutrition; peritoneal dialysis; uremic anorexia;
TNF-&agr; cholecystokinin; neuropeptide Y; acidosis
ORIGINAL ARTICLES
Anorexigen (TNF-&agr; cholecystokinin) and orexigen (neuropeptide Y) plasma levels in peritoneal dialysis (PD) patients: their relationship with nutritional parameters
Servico de Nefrologia, and Laboratory of Gastroenterology, Hospital Universitaro La Paz, Castellana 261, E-28046-Madrid, Spain; Corresponding author
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