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Katkov A, Sinuani I, Azar A, Shapiro G, Efrati S, Beberashvili I. Age modifies the association between serum obestatin, appetite and nutritional status in maintenance hemodialysis patients. Eur J Clin Nutr 2018; 72:1007-1018. [PMID: 29362457 DOI: 10.1038/s41430-018-0087-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 12/20/2017] [Accepted: 12/27/2017] [Indexed: 01/10/2023]
Abstract
BACKGROUND/OBJECTIVES Increased age is strongly associated with anorexia and protein-energy wasting (PEW) in maintenance hemodialysis (MHD) population. We hypothesized that the association of obestatin, a recently discovered anorexigenic gut hormone, with appetite and nutritional status differs by age groups. SUBJECTS/METHODS We performed a cross-sectional study on 261MHD patients. Obestatin, acyl-ghrelin, markers of inflammation (CRP, IL-6, TNF-α) and nutrition (self-reported appetite, dietary intake, biochemical nutritional parameters, and body composition) were measured. RESULTS Obestatin was associated with appetite in multivariate analyses even after controlling for such confounders as lean body mass (LBM), IL-6 and acyl-ghrelin in patients younger than 71 years. For each ng/ml increase in obestatin levels, the odds for diminished appetite was 0.75 (95% CI: 0.59-0.96). However, these associations were not observed in patients 71 years and older. Multivariable logistic regression models (including appetite) also showed increasing odds for PEW (defined by ESPEN consensus-based criteria for the diagnosis of malnutrition) across increasing serum obestatin levels (OR: 1.51, 95% CI: 1.05-2.18) in patients 71 years and older. However, after lean body mass (LBM) was added to this model, the association between obestatin and malnutrition was abolished (OR: 1.26, 95% CI: 0.83-1.91). CONCLUSIONS The association between serum obestatin, appetite and PEW differs depending on age in MHD patients. A positive link with appetite exists in patients younger than 71 years, whereas this relationship disappears by the age of 71. In older MHD patients, obestatin is associated with PEW through mechanisms related to LBM, but not to appetite.
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Affiliation(s)
- Anna Katkov
- Nephrology Division, Assaf Harofeh Medical Center, Zerifin, Affiliated to Sackler Faculty of Medicine Tel Aviv University, Tel Aviv, Israel
| | - Inna Sinuani
- Pathology Department, Assaf Harofeh Medical Center, Zerifin, Affiliated to Sackler Faculty of Medicine Tel Aviv University, Tel Aviv, Israel
| | - Ada Azar
- Nutrition Department, Assaf Harofeh Medical Center, Zerifin, Affiliated to Sackler Faculty of Medicine Tel Aviv University, Tel Aviv, Israel
| | - Gregory Shapiro
- Nephrology Division, Assaf Harofeh Medical Center, Zerifin, Affiliated to Sackler Faculty of Medicine Tel Aviv University, Tel Aviv, Israel
| | - Shai Efrati
- Nephrology Division, Assaf Harofeh Medical Center, Zerifin, Affiliated to Sackler Faculty of Medicine Tel Aviv University, Tel Aviv, Israel
| | - Ilia Beberashvili
- Nephrology Division, Assaf Harofeh Medical Center, Zerifin, Affiliated to Sackler Faculty of Medicine Tel Aviv University, Tel Aviv, Israel.
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Bruzzese A, Lacquaniti A, Cernaro V, Ricciardi CA, Loddo S, Romeo A, Montalto G, Costantino G, Torre F, Pettinato G, Salamone I, Aloisi C, Santoro D, Buemi M. Sclerostin levels in uremic patients: a link between bone and vascular disease. Ren Fail 2016; 38:759-64. [PMID: 27001371 DOI: 10.3109/0886022x.2016.1160207] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Sclerostin is a marker of low-turnover bone disease in end stage renal disease patients. The aim of this study was to evaluate serum sclerostin in uremic patients, analyzing its behavior during a single hemodialysis session. Twenty-one adult patients on intermittent hemodialysis treatment were enrolled. Acetate Free Bio-filtration (AFB) was the technique employed. Uremic patients were characterized by higher levels of serum sclerostin when compared with values observed in healthy subjects. Sclerostin assessed in pre-dialysis samples was 1.4 ± 1.02 ng/mL, whereas, in post dialysis samples, a reduction of sclerostin values was observed (0.8 ± 0.6 ng/mL; p: 0.008). Sclerostin correlated with parameters of dialysis adequacy, such as creatinine levels and Kt/V values, and it was significantly associated with atherosclerotic disease. Receiver operating characteristics analysis revealed a good diagnostic profile in identifying atherosclerotic disease. Sclerostin, a full dialyzable substance during AFB dialysis, is closely associated with atherosclerotic disease. Its reduction obtained through AFB could represent a defensive mechanism, improving vascular disease and renal osteodystrophy.
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Affiliation(s)
- Annamaria Bruzzese
- a Department of Clinical and Experimental Medicine , University of Messina , Messina , Italy
| | - Antonio Lacquaniti
- a Department of Clinical and Experimental Medicine , University of Messina , Messina , Italy
| | - Valeria Cernaro
- a Department of Clinical and Experimental Medicine , University of Messina , Messina , Italy
| | - Carlo Alberto Ricciardi
- a Department of Clinical and Experimental Medicine , University of Messina , Messina , Italy
| | - Saverio Loddo
- b Department of Pathology , University of Messina , Messina , Italy
| | - Adolfo Romeo
- a Department of Clinical and Experimental Medicine , University of Messina , Messina , Italy
| | - Gaetano Montalto
- a Department of Clinical and Experimental Medicine , University of Messina , Messina , Italy
| | - Giuseppe Costantino
- a Department of Clinical and Experimental Medicine , University of Messina , Messina , Italy
| | - Francesco Torre
- a Department of Clinical and Experimental Medicine , University of Messina , Messina , Italy
| | - Giuseppina Pettinato
- a Department of Clinical and Experimental Medicine , University of Messina , Messina , Italy
| | - Ignazio Salamone
- c Department of Biomedical Sciences and Morphological and Functional Imaging , University of Messina , Messina , Italy
| | - Carmela Aloisi
- a Department of Clinical and Experimental Medicine , University of Messina , Messina , Italy
| | - Domenico Santoro
- a Department of Clinical and Experimental Medicine , University of Messina , Messina , Italy
| | - Michele Buemi
- a Department of Clinical and Experimental Medicine , University of Messina , Messina , Italy
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Visconti L, Santoro D, Cernaro V, Buemi M, Lacquaniti A. Kidney-lung connections in acute and chronic diseases: current perspectives. J Nephrol 2016; 29:341-348. [PMID: 26940339 DOI: 10.1007/s40620-016-0276-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 01/30/2016] [Indexed: 02/06/2023]
Abstract
Lung and kidney functions are intimately related in both health and disease. The regulation of acid-base equilibrium, modification of partial pressure of carbon dioxide and bicarbonate concentration, and the control of blood pressure and fluid homeostasis all closely depend on renal and pulmonary activities. These interactions begin in fetal age and are often responsible for the genesis and progression of diseases. In gestational age, urine is a fundamental component of the amniotic fluid, acting on pulmonary maturation and growth. Moreover, in the first trimester of pregnancy, kidney is the main source of proline, contributing to collagen synthesis and lung parenchyma maturation. Pathologically speaking, the kidneys could become damaged by mediators of inflammation or immuno-mediated factors related to a primary lung pathology or, on the contrary, it could be the renal disease that determines a consecutive pulmonary damage. Furthermore, non immunological mechanisms are frequently involved in renal and pulmonary diseases, as observed in chronic pathologies such as sleep apnea syndrome, pulmonary hypertension, progressive renal disease and hemodialysis. Kidney damage has also been related to mechanical ventilation. The aim of this review is to describe pulmonary-renal interactions and their related pathologies, underscoring the need for a close collaboration between intensivists, pneumologists and nephrologists.
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Affiliation(s)
- Luca Visconti
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Domenico Santoro
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Valeria Cernaro
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Michele Buemi
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Antonio Lacquaniti
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.
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Mondello P, Lacquaniti A, Mondello S, Bolignano D, Pitini V, Aloisi C, Buemi M. Emerging markers of cachexia predict survival in cancer patients. BMC Cancer 2014; 14:828. [PMID: 25400234 PMCID: PMC4239407 DOI: 10.1186/1471-2407-14-828] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Accepted: 10/29/2014] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Cachexia may occur in 40% of cancer patients, representing the major cause of death in more than 20% of them. The aim of this study was to investigate the role of leptin, ghrelin and obestatin as diagnostic and predictive markers of cachexia in oncologic patients. Their impact on patient survival was also evaluated. METHODS 140 adults with different cancer diagnoses were recruited. Thirty healthy volunteers served as control. Serum ghrelin, obestatin and leptin were tested at baseline and after a follow-up period of 18 months. RESULTS Ghrelin levels were significantly higher in cancer patients than in healthy subjects (573.31 ± 130 vs 320.20 ± 66.48 ng/ml, p < 0.0001), while obestatin (17.42 ± 7.12 vs 24.89 ± 5.54 ng/ml, p < 0.0001) and leptin (38.4 ± 21.2 vs 76.28 ± 17.48 ng/ml, p < 0.0001) values were lower. At ROC analyses the diagnostic profile of ghrelin (AUC 0.962; sensitivity 83%; specificity 98%), obestatin (AUC 0.798; sensitivity 74.5%; specificity 81.5%) and leptin (AUC 0.828; sensitivity 79%; specificity 73%) was superior to that of albumin (AUC 0.547; sensitivity 63%, specificity 69.4%) for detecting cachexia among cancer patients. On Cox multivariate analyses ghrelin (HR 1.02; 95% CI 1.01 - 1.03; p < 0.0001) and leptin (HR 0.94; 95% CI 0.92 - 0.96; p < 0.0001) were significant predictors of death even after correction for other known risk factors such as presence of metastasis and chronic kidney disease. CONCLUSION Ghrelin and leptin are promising biomarkers to diagnose cachexia and to predict survival in cancer patients.
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Affiliation(s)
- Patrizia Mondello
- />Department of Human Pathology, University of Messina, Via Consolare Valeria, 98125 Messina, Italy
| | - Antonio Lacquaniti
- />Department of Internal Medicine, University of Messina, Messina, Italy
| | - Stefania Mondello
- />Department of Neurosciences, University of Messina, Messina, Italy
| | | | - Vincenzo Pitini
- />Department of Human Pathology, University of Messina, Via Consolare Valeria, 98125 Messina, Italy
| | - Carmela Aloisi
- />Department of Internal Medicine, University of Messina, Messina, Italy
| | - Michele Buemi
- />Department of Internal Medicine, University of Messina, Messina, Italy
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Shen C, Yu T, Tang ZH, Wu KM. Changes in ghrelin and obestatin levels before and after a meal in children with simple obesity and anorexia. Horm Res Paediatr 2014; 79:341-6. [PMID: 23774845 DOI: 10.1159/000351464] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Accepted: 04/18/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Obestatin and ghrelin both have effects on the hypothalamus which controls food intake. We hypothesize that the circulating levels of obestatin and ghrelin may change after a meal and might be different between obesity and anorexia, which might be relevant to anorexia or obesity. METHOD Fifteen children with obesity, 25 children with anorexia and 17 normal-weight healthy controls were enrolled in the study. The preprandial and postprandial glucose, insulin, total ghrelin and obestatin tests were completed in the three groups. The values of these indices were compared. RESULTS The obesity group had the highest values for BMI and fasting glucose (p < 0.001), while the anorexia group had the highest values for obestatin and ghrelin, followed by the control and obesity groups. No differences in ratios of ghrelin to obestatin were found between the anorexia and obesity groups (p > 0.05), but both were higher than that of the control group (p < 0.05). BMI was negatively correlated with preprandial obestatin (r = -0.8413, p < 0.001) and ghrelin (r = -0.7400, p < 0.001), but showed no significant correlations with the ghrelin-to-obestatin ratio. CONCLUSION Although there is still controversy between the present and previous studies, the present study show that levels of obestatin and ghrelin are inversely correlated with BMI.
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Affiliation(s)
- Chuan Shen
- Department of Laboratory Medicine West China Second University Hospital, Sichuan University, Chengdu, China
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Low serum concentration of obestatin as a predictor of mortality in maintenance hemodialysis patients. BIOMED RESEARCH INTERNATIONAL 2013; 2013:796586. [PMID: 24102059 PMCID: PMC3786512 DOI: 10.1155/2013/796586] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Accepted: 07/19/2013] [Indexed: 12/04/2022]
Abstract
Obestatin, a proposed anorexigenic gut hormone, has been shown to have a number of beneficial cardiotropic effects in experimental studies. We hypothesized that obestatin alteration in hemodialysis patients may link to clinical outcomes. This cross-sectional study with prospective followup for almost 4 years was performed on 94 prevalent hemodialysis patients. Obestatin, leptin, proinflammatory cytokines (tumor necrosis factor-α [TNF-α], interleukin-6, and various nutritional markers were measured. Patients with low obestatin levels, defined as a level less than median, had a worse all-cause mortality and cardiovascular mortality. The crude all-cause (HR 2.23, 95% CI 1.17 to 4.24) and cardiovascular mortality hazard ratios (HR 4.03, 95% CI 1.27 to 12.76) in these patients continued to be significant after adjustment for various confounders for all-cause mortality. Across the four obestatin-TNF-α categories, the group with low obestatin and high TNF-α (above median level) exhibited a worse outcome in both all-cause mortality and cardiovascular mortality. Clinical characteristics of patients in low obestatin high TNF-α group did not differ from other obestatin-TNF-α categorized groups. In summary, low serum obestatin concentration is an independent predictor of mortality in prevalent hemodialysis patients. Novel interactions were observed between obestatin and TNF-α, which were associated with mortality risk, especially those due to cardiovascular causes.
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Low Serum Concentration of Obestatin as a Predictor of Mortality in Maintenance Hemodialysis Patients. BIOMED RESEARCH INTERNATIONAL 2013. [DOI: 10.1155/2013/796586 www.ncbi.nlm.nih.gov/pmc/articles/pmc3786512] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Obestatin, a proposed anorexigenic gut hormone, has been shown to have a number of beneficial cardiotropic effects in experimental studies. We hypothesized that obestatin alteration in hemodialysis patients may link to clinical outcomes. This cross-sectional study with prospective followup for almost 4 years was performed on 94 prevalent hemodialysis patients. Obestatin, leptin, proinflammatory cytokines (tumor necrosis factor-α[TNF-α], interleukin-6, and various nutritional markers were measured. Patients with low obestatin levels, defined as a level less than median, had a worse all-cause mortality and cardiovascular mortality. The crude all-cause (HR 2.23, 95% CI 1.17 to 4.24) and cardiovascular mortality hazard ratios (HR 4.03, 95% CI 1.27 to 12.76) in these patients continued to be significant after adjustment for various confounders for all-cause mortality. Across the four obestatin-TNF-αcategories, the group with low obestatin and high TNF-α(above median level) exhibited a worse outcome in both all-cause mortality and cardiovascular mortality. Clinical characteristics of patients in low obestatin high TNF-αgroup did not differ from other obestatin-TNF-αcategorized groups. In summary, low serum obestatin concentration is an independent predictor of mortality in prevalent hemodialysis patients. Novel interactions were observed between obestatin and TNF-α, which were associated with mortality risk, especially those due to cardiovascular causes.
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From chronic kidney disease to transplantation: the roles of obestatin. ACTA ACUST UNITED AC 2011; 171:48-52. [PMID: 21784109 DOI: 10.1016/j.regpep.2011.07.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2011] [Revised: 05/18/2011] [Accepted: 07/08/2011] [Indexed: 11/22/2022]
Abstract
BACKGROUND Kidney transplantation is the therapy of choice in most cases of end stage renal disease. The purpose of the present study was to evaluate serum obestatin levels in kidney transplant recipients (Tx), compare levels in patients with renal failure (CKD) with those in healthy subjects (HS), and to assess the role of this hormone in energetic metabolism. PATIENTS AND METHODS A total of 95 subjects were studied: 40 were Tx; 35 had CKD and 20 were HS. Inclusion criteria were age>18years and good allograft function. Patients with an inflammatory disease or a diagnosis of cancer were excluded from the study. RESULTS Obestatin levels in Tx patients were significantly lower than in HS (3.5 [3-4.8] versus 11 [8.56-28.60] ng/mL; p<0.0001) and patients with CKD (3.5 [3-4.8] versus 4.7 [3, 5-6, 1] ng/mL; p=0.008). At univariate analysis, a direct correlation was found between obestatin and calcemia (p: 0.0001; r: 0.51), phosphoremia (p: 0.0005; r: 0, 46), calcium-phosphate product (p<0.0001; r:0.53), and parathormone (p: 0.01; r: 0.32), whereas significant inverse correlations were evidenced for BMI (p<0.0001; r: -0.52). At multivariate analysis, significance was maintained for the correlation between obestatin and phosphoremia (β=0.47; p=0.008), for the calcium-phosphate product (β=0.55; p=0.0005) and for BMI (β=-0.53; p=0.01). CONCLUSION Obestatin, present in lower levels in Tx patients than in CKD patients and HS, plays a role in energy metabolism, affecting BMI and the metabolism of calcium-phosphorus.
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Lacquaniti A, Donato V, Chirico V, Buemi A, Buemi M. Obestatin: An Interesting but Controversial Gut Hormone. ANNALS OF NUTRITION AND METABOLISM 2011; 59:193-9. [DOI: 10.1159/000334106] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2011] [Accepted: 09/30/2011] [Indexed: 12/14/2022]
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