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Identifier 000378398
Title Συσχέτιση της κατάστασης θρέψης με δείκτες φλεγμονής σε ασθενείς με σταδίου 5 ΧΝΝ
Alternative Title Association among the nutritional status and the inflammatory markers of the stage renal disease patients
Author Μαρκάκη, Αναστασία
Thesis advisor Δαφνής, Ευγένιος
Reviewer Μαργίωρής, Ανδρέας
Γανωτάκης, Εμμανουήλ
Λιονής, Χρήστος
Φιλαλήθης, Αναστάσιος
Βενυχάκη Μαρία
Χατζή, Λήδα
Abstract Introduction: Protein-energy wasting (PEW) is very frequent among patients with end stage renal disease (ESRD), contributing to their high mortality rate. The levels of adipokines, adiponectin (ADPN) and leptin are almost three times higher in ESRD patients in comparison with the general population. Research has shown conflicting results concerning the association of ADPN and leptin with PEW and mortality. Aims: In this study, we investigated the prevalence of PEW in hemodialysis (HD) and peritoneal dialysis (PD) patients and the relation between ADPN and leptin levels with nutritional and inflammatory markers in ESRD patients and their possible role in PEW and mortality. Methods: 74 ESRD patients, forty-seven (26 men and 21 women) on hemodialysis (HD), and 27 (15 men and 12 women) on peritoneal dialysis (PD), were assessed at three sequential time points (baseline, 6 and 18 months) for their nutritional and inflammatory status and were followed-up for the following 50 months for all-cause mortality. Anthropometric measurements (weight, height, arm, waist and hip circumferences), body composition (triceps skinfold and bio-impedance analysis) and biochemical analysis (albumin, pre-albumin, IL-6, CRP, total cholesterol, phosphorus etc) were assessed for all patients. Serum ADPN and leptin were also measured at each time point. Patients were stratified in 3 groups according to PEW severity (0, 1-2 and&ge;3 criteria for PEW). Diagnosis of PEW included body mass index (BMI)<23, reduction of arm muscle area (AMA) more than 10% below 50th percentile, percentage of body fat (%BF) below 10% of body weight and serum albumin levels <3.8gr/dl and pre-albumin <30mgr/dl. Results: Adiponectin and leptin levels were higher in PD than in HD patients (p=0.035). The prevalence of PEW (&ge;3 criteria) was also higher in PD vs. HD patients (22.2% vs. 8.5% respectively), whereas a higher proportion of well-nourished patients (none criterion of PEW) was noticed in HD than in PD (21.3% vs. 18.5% respectively). However, both differences didn’t reach a statistical significance. ADPN levels were consistently higher in all 5 PEW criteria examined and increased from lower to higher PEW stratum (p=0.002). Leptin showed the opposite trend, with lower 8 levels in malnourished patients (&ge;3 criteria of PEW) and higher levels in patients with zero PEW criteria (p=0.042). Alterations of ADPN levels during the observation period were dependent on PEW (p=0.021) and the mode of dialysis (p=0.002) (after adjustment for age, dialysis vintage, gender and fat mass index -FMI-). In particular HD patients with &ge;3 criteria of PEW increased adiponectin levels over time, whereas PD patients with &ge;3 criteria decreased adiponectin levels throughout the study. Leptin alterations over time were not affected by the mode of dialysis or the PEW. In cox regression and multiple cox proportional hazard models, each 1μg/ml increment of ADPN levels was associated with 4% (p=0.013) and 9% increase (p=0.003) in mortality risk respectively. Furthermore, the lowest sex-specific tertile of leptin (<5.1 for men and <14.9ng/ml for women) was associated with higher risk of all-cause mortality compared with middle and highest tertiles [crude hazard ratio: 2.95 (95% CI, 1.17–7.50)]. This low leptin-mortality association persisted even after adjustment for FMI, age, sex, dialysis mode, baseline CVD, serum albumin and CRP. Conclusions: Our study provides strong evidence that increased ADPN and decreased leptin are independently associated with poor prognosis and PEW. The way that these two adipokines differentially impact on PEW and mortality warrants further investigation.
Language Greek
Subject Adiponectin
End stage renal disease
Leptin
Mortality
Protein-energy wasting
Urogenital system
Urogenital system Kidney
Αδιπονεκτίνη
Θνησιμότητα
Λεπτίνη
Πρωτεινο-ενεργειακή δυσθρεψία
Τελικού σταδίου νόσος
Issue date 2013-04-16
Collection   School/Department--School of Medicine--Department of Medicine--Doctoral theses
  Type of Work--Doctoral theses
Permanent Link https://elocus.lib.uoc.gr//dlib/3/1/a/metadata-dlib-1374145639-535859-20700.tkl Bookmark and Share
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