Associations between plasma ghrelin levels and body composition in end-stage renal disease:: a longitudinal study

Background. Ghrelin is a newly detected orexigenic gastric hormone that stimulates food intake. Increased levels of ghrelin are often found in disease states associated with wasting. Wasting is a common phenomenon in end-stage renal disease (ESRD) patients in whom elevated ghrelin levels have been reported. However, no data are available on the relationship between body composition and plasma ghrelin levels in this patient group. Methods. The study population consisted of 108 (71 males) ESRD patients aged 53 +/- 12 years. Body composition, nutritional status (subjective global assessment), estimated protein intake (nPNA), plasma ghrelin, plasma insulin and serum leptin were evaluated close to the start of dialysis treatment. Twelve healthy subjects (nine males, 44 +/- 6 years) served as the control group. A longitudinal evaluation of changes in plasma ghrelin and body composition was performed in 52 of the patients after 12 months of dialysis treatment. Results. Markedly elevated plasma ghrelin levels (843 +/- 485 vs 443 +/- 302 pg/ml; P < 0.01) were observed in ESRD patients compared with controls. Basal plasma ghrelin levels correlated significantly with plasma insulin (R = -0.32; P < 0.05), body mass index (R = -0.24; P < 0.05), log serum leptin levels (R = -0.23; P < 0.05) and truncal fat mass (R = -0.25; P < 0.05). The longitudinal analysis of body composition demonstrated that whereas fat mass increased (23.7 +/- 8.6 to 25.3 +/- 9.9 kg; P < 0.05) and plasma ghrelin levels decreased (855 +/- 429 to 693 +/- 408 pg/ml; P < 0.05) significantly in peritoneal dialysis patients, no significant changes in either body composition or plasma ghrelin levels were found in patients treated by haemodialysis. Conclusion. Markedly elevated plasma ghrelin levels are found in advanced renal failure and correlate with fat mass, plasma insulin and serum leptin levels. Changes in plasma ghrelin during 12 months of peritoneal dialysis treatment are associated with changes in body composition.