Abstract
Aim: Diabetes mellitus (DM) is a proven risk factor for diseases such as end stage renal disease (ESRD) and osteoarthritis (OA). Thus, it is not unreasonable to assume that some of the ESRD/ OA pathogenesis, namely inflammation and metabolic dysfunction, could be attributed to DM as a comorbititiy. This study aims to investigate DM's effect on metabolic biomarker levels in patients with ESRD or undergoing total joint arthroplasty. Methods: Under IRB approval, plasma samples were collected from 82 patients with ESRD prior to hemodialysis and from 39 patients prior to total hip and knee arthroplasty. Normal human plasma samples (female & male, 18-35 years old) were purchased from George King Biomedical Inc. (Overland Park, KS). Samples were stored at -80°C. Metabolic biochips were purchased from RANDOX (Co. Antrim, Northern Ireland) to test c-peptide, ferritin, IL-6, resistin, insulin, TNF-α, IL-1α, leptin and PAI-1. These biomarkers were tested in two batches: 82 ESRD and 17 normals, and 39 TJA and 25 normals. Results & Conclusions: All biomarkers, except insulin, were significantly elevated in ESRD+DM compared to normal. For TJA+DM vs. normal, all biomarkers were increased except c-peptide and insulin, which were decreased, and ferritin, which showed no significant change. The only biomarker significantly increased in ESRD+DM compared to ESRD-DM, was leptin. Furthermore, ESRD+DM vs. normal were significant for leptin, but ESRD-DM vs. normal was not. This pattern is consistent with the leptin pattern seen in patients with ESRD+MetS. This suggests that elevated leptin levels seen in patients with ESRD may be due to DM and/or MetS, which are both highly prevalent in the ESRD population. For all other biomarkers, there was lack of significance in ESRD+DM vs. ESRD-DM, as well as in TJA+DM vs. TJA-DM. This suggests that the presence of DM may not substantially further alter the metabolic profiles seen in patients with ESRD or undergoing TJA.
Highlights
Diabetes mellitus (DM) is a proven risk factor for diseases such as end stage renal disease (ESRD) and osteoarthritis (OA) [1,2,3]
The following biomarkers were significantly elevated in patients with ESRD compared to normal: c-peptide, ferritin, Interleukin 6 (IL-6), resistin, TNF-α, IL-1α, leptin, and Plasminogen activator inhibitor 1 (PAI-1) as shown in table 2 and figure 2
We have previously shown that c-peptide, resistin, IL-1α, ferritin, leptin, IL-6, PAI-1 and TNF-α are all increased in patients with ESRD compared to normal, while insulin is not [22]
Summary
Diabetes mellitus (DM) is a proven risk factor for diseases such as end stage renal disease (ESRD) and osteoarthritis (OA) [1,2,3]. It is not unreasonable to assume that some of the ESRD/OA pathogenesis, namely inflammation and metabolic dysfunction, could be attributed to DM as a comorbititiy. This study aims to investigate DM's effect on metabolic biomarker levels in patients with ESRD or undergoing total joint arthroplasty. Its advancement to ESRD, has previously been linked to risk factors such as diabetes, hypertension and glomerulonephritis [1]. ESRD is marked by failure to remove waste products and uremia, requiring hemodialysis. An abnormal milieu of serum proteins and compounds, including metabolic waste products, would be expected in patients with ESRD. Whether or not part of the abnormal metabolic profile can be attributed to DM as a comorbitity or causative factor, is unclear
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