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NDT Advance Access published online on September 19, 2009
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfp493
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© The Author 2009. Published by Oxford University Press [on behalf of ERA-EDTA]. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org


Impairment of endogenous melatonin rhythm is related to the degree of chronic kidney disease (CREAM study)

Birgit C. P. Koch1, Karien van der Putten2, Eus J. W. Van Someren3,4, Jos P. M. Wielders5, Piet M. Ter Wee6, J. Elsbeth Nagtegaal1 and Carlo A. J. M. Gaillard2

1 Department of Clinical Pharmacy 2 Department of Internal Medicine, Meander MC, Amersfoort 3 Netherlands Institute for Neuroscience 4 Departments of Neurology, Clinical Neurophysiology and Medical Psychology, VU University Medical Center, Amsterdam 5 Department of Clinical Chemistry, Meander MC, Amersfoort 6 Department of Nephrology, VU University Medical Center, Amsterdam, The Netherlands

Correspondence and offprint requests to: Birgit C. P. Koch; E-mail: B.Koch{at}vumc.nl



  Abstract

Background. The nocturnal endogenous melatonin rise, which is associated with the onset of sleep propensity, is absent in haemodialysis patients. Information on melatonin rhythms in chronic kidney disease (CKD) is limited. Clear relationships exist between melatonin, core body temperature and cortisol in healthy subjects. In CKD, no data are available on these relationships. The objective of the study was to characterize the rhythms of melatonin, cortisol and temperature in relation to renal function in patients with CKD.

Methods. From 28 patients (mean age 71 years) with various degrees of renal function, over a 24-h period, blood samples were collected every 2 h. An intestinal telemetric sensor was used to measure core temperature. The presence of diurnal rhythms was examined for melatonin, temperature and cortisol. Correlation analysis was performed between Cockcroft–Gault GFR (GFR), melatonin, cortisol and temperature parameters.

Results. The mean GFR was 57 ± 30 ml/min. The subjects exhibited melatonin (n = 24) and cortisol (n = 22) rhythms. GFR was significantly correlated to melatonin amplitude (r = 0.59, P = 0.003) and total melatonin production (r = 0.51, P = 0.01), but not to temperature or cortisol rhythms. Interestingly, no associations were found between the rhythms of temperature, melatonin and cortisol.

Conclusions. As melatonin amplitude and melatonin rhythm decreased with advancing renal dysfunction, follow-up research into circadian rhythms in patients with CKD is warranted.

Keywords: chronic kidney disease; circadian rhythm; core body temperature; cortisol; melatonin

Received for publication: 14. 5.09
Accepted in revised form: 24. 8.09


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