ESPN 50th Annual Meeting

ESPN 2017


 
Ghrelin and Leptin Levels in Relation to Body Fat Mass in Children with Chronic Kidney Disease
NUR CANPOLAT 1 AYSE AGBA┼× 1 CIGDEM ORUC 1 OZLEM BALCI EKMEKCI 2 FATMA LALE SEVER 1 SALIM CALISKAN 1

1- ISTANBUL UNIVERSITY CERRAHPASA MEDICAL FACULTY, DEPARTMENT OF PEDIATRIC NEPHROLOGY
2- ISTANBUL UNIVERSITY CERRAHPASA MEDICAL FACULTY, DEPARTMENT OF BIOCHEMISTRY
 
Introduction:

The mechanism causing decreased appetite in uremia is not fully understood. Hormonal and metabolic abnormalities, particularly alterations in appetite-regulating hormones have been suggested as causative factors. The aim of the present study was to evaluate serum concentrations of total ghrelin and leptin, and their possible interactions with fat mass, inflammation, insulin resistance and 25(OH) vitamin D levels in children with chronic kidney disease (CKD).

Material and methods:

The study population consisted of 94 patients with CKD [20 patients with CKD stages 2-4, 39 patients on chronic dialysis (22 PD, 17 HD) and 35 renal transplant (RTx) recipients] and 18 healthy controls. Nutritional status was assessed by measuring body mass index (BMI) and multi-frequency bioimpedance analysis (BIA). Fat mass was estimated by the BIA method. Serum total ghrelin, leptin and IL-6 were measured by ELISA method in all patients and controls. High sensitive (hs)-CRP, fasting glucose and insulin, and 25(OH) vitamin D levels were recorded from patients’ file. Insulin resistance was estimated by the homeostasis model assessment of insulin resistance (HOMA-IR). 

Results:

The mean total ghrelin level was significantly higher in patients on dialysis than the controls, CKD patients and RTx recipients (p<0.001 for all). There was no difference considering total ghrelin levels between controls and CKD or RTx recipients. Total ghrelin levels in dialysis patients were negatively correlated with fat mass (p=0.002), fat mass (%)-z score for height-age (p=0.004), BMI-SDS for height-age (p=0.015), albumin (p=0.030) and 25(OH) vitamin D level (p=0.036). Multivariate analysis showed that a lower fat mass was the only independent predictor of increased total ghrelin levels in dialysis patients (p=0.015). Leptin levels were also higher in patient groups compared with healthy controls but the differences were not statistically significant. Higher serum leptin levels in all patients were independently associated with increased fat mass (p<0.001). 

Conclusions:

 Poor nutritional status appears to be the most important cause of high total ghrelin levels in dialysis patients. Leptin is closely associated with increased fat mass in all CKD patients.