Abstract
Background: Appetite disorders are frequent and scantly studied in peritoneal dialysis (PD) patients and are associated with malnutrition and cardiovascular complications.Objective: We investigated the relationship between uremic insulin resistance, pro-inflammatory cytokines, and appetite-related peptides release (ARPr) with eating-behavior disorders in PD patients.Methods: We included 42 PD patients (12 suffering anorexia, 12 obese with high food-intake, and 18 asymptomatic) and 10 controls. We measured blood levels of ARPr including orexigens [neuropeptide-Y (NPY), ghrelin, and nitric-oxide], anorexigens [cholecystokinin, insulin, corticotropin-releasing factor, leptin, and adiponectin (Ad)], and cytokines (TNF-α, sTNFα-R2, and IL-6) both at baseline and after administering a standard-food stimulus (SFS). We also measured the expression of TNF-α, leptin and Ad-encoding mRNAs in abdominal adipose tissue. We compared these markers with eating motivation measured by a Visual Analog Scale (VAS).Results: Anorexics showed both little appetite, measured by a VAS, and low levels of orexigens that remained constant after SFS, coupled with high levels of anorexigens at baseline and after SFS. Obeses showed higher appetite, increased baseline levels of orexigens, lower baseline levels of anorexigens and cytokines and two peaks of NPY after SFS. The different patterns of ARPr and cytokines pointed to a close relationship with uremic insulin resistance. In fact, the euglycemic–hyperglycemic clamp reproduced these disorders. In anorexics, TNF-α fat expression was increased. In obese patients, leptin expression in fat tissue was down-regulated and showed correlation with the appetite.Conclusion: In PD, appetite is governed by substances that are altered at baseline and abnormally released. Such modulators are controlled by insulin metabolism and cytokines and, while anorexics display inflammatory predominance, obese patients predominantly display insulin resistance.
Highlights
Malnutrition is a severe and frequent (20–40%) complication in peritoneal dialysis (PD) patients
We demonstrate that patients suffering anorexia showed the minimal score of hunger, lower palatability and eating desire, in conjunction with a sensation of greater fullness, contrasting with the features found in obese patients
Our PD patients showed high spontaneous baseline plasma levels of anorexigenic peptides and cytokines, including C-peptide and Gastric inhibitory peptide (GIP), which have an anorexigenic effect mediated by insulinglucose metabolism
Summary
Malnutrition is a severe and frequent (20–40%) complication in peritoneal dialysis (PD) patients. EBD in PD patients may range from anorexia to obesity with high food intake. Anorexia is the main obstacle to achieve an adequate nutritional status, while obesity is frequently associated with protein malnutrition, inducing a Kwashiorkor-like syndrome (Aguilera et al, 2004b). The inflammation may play a role in the genesis of appetite disorders in these patients (Aguilera et al, 2004b; Chazot, 2009). Appetite disorders are frequent and scantly studied in peritoneal dialysis (PD) patients and are associated with malnutrition and cardiovascular complications
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