NDT Advance Access published online on May 23, 2008
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfn297
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Short-term regulation of peptide YY secretion by a mixed meal or peritoneal glucose-based dialysate in patients with chronic renal failure
1 Department of Medicine, University of A Coruña 2 Divisions of Nephrology 3 Endocrinology 4 Laboratory, University Hospital Juan Canalejo, Spain
Correspondence and offprint requests to: Miguel Pérez-Fontán, Division of Nephrology, University Hospital Juan Canalejo, Xubias 84, 15006 A Coruña, Spain. Tel: +34-981178159; Fax: +34-981178159; E-mail: mfontan{at}canalejo.org
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Abstract |
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Background. Malnutrition is very prevalent among patients with chronic renal failure. The role of derangements in the gut–brain axis for regulation of appetite in the genesis of anorexia of these patients has not been adequately investigated.
Design. Following a randomized, crossover design, we analysed plasma levels of peptide YY (PYY)1–36 and PYY3–36 both fasting and after a standardized oral mixed meal or intraperitoneal glucose infusion in 10 stable uraemic patients undergoing peritoneal dialysis and 8 healthy controls, matched for age, gender and body mass index.
Main results. Median baseline plasma levels of PYY1–36 in the different provocation tests oscillated between 406 and 460 pg/mL in patients, as compared with 73 and 100 pg/mL in controls (P < 0.001). Corresponding values for PYY3–36 oscillated between 235 and 267 pg/mL in patients, versus 56 and 70 pg/mL in controls (P < 0.001). The association of high levels of PYY3–36 and normal levels of acylated ghrelin (when compared with healthy controls) configurated a markedly pro-anorexigenic pattern in patients. Neither oral intake nor intraperitoneal glucose resulted in significant changes in plasma levels of PYY1–36 or PYY3–36 in subjects with renal failure, in contrast with the expected postprandial rise observed in healthy controls (41% for PYY1–36, P = 0.04 and 32% for PYY3–36, P = 0.02, median values).
Conclusions. Baseline plasma levels of PYY1–36 or PYY3–36 are markedly elevated in patients with renal failure undergoing peritoneal dialysis. Provocation studies disclose a marked disregulation in the postprandial secretion of these anorexigenic peptides, when compared with healthy controls. These findings may contribute to clarify the complex pathogenesis of anorexia of chronic renal failure.
Keywords: anorexia; ghrelin; peritoneal dialysis; PYY; renal failure
Received for publication: 12. 2.08
Accepted in revised form: 30. 4.08
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