Interaction between acyl-ghrelin and BMI predicts clinical outcomes in hemodialysis patients

BMC Nephrology

Research Article

Inna Sinuani¹  Ilia Beberashvili²  Keren Doenyas-Barak²  Leonid Feldman²  Gregory Shapiro²  Shai Efrati²  Ada Azar³  Kobi Stav⁴ 

[1] Department of pathology, Assaf Harofeh Medical Center, Zerifin. Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel;Nephrology Division, Assaf Harofeh Medical Center, Zerifin. Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel;Nutrition Department, Assaf Harofeh Medical Center, Zerifin. Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel;Urology Department, Assaf Harofeh Medical Center, Zerifin. Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel;

关键词: Ghrelin;    Acyl-ghrelin;    BMI;    Fat mass;    Appetite;    Hemodialysis;    Survival;    Inflammation;   

DOI  :  10.1186/s12882-017-0442-8

 received in 2016-09-13, accepted in 2017-01-06,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundGhrelin, a gastric orexigenic peptide, and body mass index (BMI) are known as inversely associated to each other and are both linked to cardiovascular (CV) risk and mortality in maintenance hemodialysis (MHD) patients. However, it is unclear whether the interaction between ghrelin and BMI is associated with a risk of all-cause and CV death in this population.MethodsA prospective observational study was performed on 261 MHD outpatients (39% women, mean age 68.6 ± 13.6 years) recruited from October 2010 through April 2012, and were followed until November 2014 (median follow-up-28 months, interquartile range-19–34 months). We measured acyl-ghrelin (AG) levels, appetite, nutritional and inflammatory markers, prospective all-cause and cardiovascular (CV) mortality.ResultsDuring follow-up, 109 patients died, 51 due to CV causes. A significant interaction effect of high BMI and high AG (defined as levels higher than median) on all-cause mortality was found. Crude Cox HR for the product termed BMI x AG was 0.52, with a 95% confidence interval (CI): 0.29 to 0.95 (P = 0.03). Evaluating the interaction on an additive scale revealed that the combined predictive value of BMI and AG is larger than the sum of their individual predictive values (synergy index was 1.1). Across the four BMI-AG categories, the group with high BMI and high AG exhibited better all-cause and cardiovascular mortality irrespective of appetite and nutritional status (multivariable adjusted hazard ratios were 0.31, 95% CI 0.16 to 0.62, P = 0.001, and 0.35, 95% CI 0.13 to 0.91, P = 0.03, respectively). Data analyses made by dividing patients according to fat mass-AG, but not to lean body mass-AG categories, provided similar results.ConclusionsHigher AG levels enhance the favourable association between high BMI and survival in MHD patients irrespective of appetite, nutritional status and inflammation.

【 授权许可】

CC BY   
© The Author(s). 2017