Protein-energy wasting and asymmetric dimethylarginine in peritoneal dialysis patients

  • Sylwia Małgorzewicz Department of Clinical Nutrition, Medical University of Gdansk, Gdańsk, Poland
  • Zbigniew Heleniak Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdansk, Gdańsk, Poland
  • Monika Lichodziejewska-Niemierko Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdansk, Gdańsk, Poland
  • Bolesław Rutkowski Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdansk, Gdańsk, Poland
  • Ewa Aleksandrowicz-Wrona Department of Clinical Nutrition, Medical University of Gdansk, Gdańsk, Poland
  • Alicja Dębska-Ślizień Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdansk, Gdańsk, Poland

Abstract

Cardiovascular (CVS) morbidity and mortality in the peritoneal dialysis patients (PD) is 10-30-fold higher than in the general population. A relatively low level of adiponectin and a higher level of leptin are important predictors of vascular complications as well as CVS events in PD patients. The asymmetric dimethylarginine (ADMA), an endogenous inhibitor of nitric oxide synthase, is an important risk factor of CVS morbidity and mortality. It is very important to establish all CVS risk factors in the PD patients to prevent CVS morbidity and mortality in this population. The aim of the study was to determine the plasma concentration of ADMA and adipokines in relation to the protein-energy wasting (PEW) in PD patients. The study was performed in 30 PD patients and in the control group which consisted of 23 healthy volunteers. Plasma levels of hsC-reactive protein, TNF, IL-6, leptin, adiponectin, oxyLDL and ADMA were measured by ELISA method in both groups. The nutritional status was determined by measuring the albumin, body mass index (BMI), the percentage of body fat (%F), lean body mass (LBM) and Subjective Global Assessment Score (SGA). The adequacy of dialysis was estimated by weekly Kt/V. In all PD patients, significantly higher levels of ADMA, leptin, oxyLDL, hsCRP and TNF in comparison to controls were observed. In contrast to well-nourished subjects, patients with PEW, in addition to increased hsCRP, showed significantly higher ADMA. PEW was associated with high levels of ADMA and hsCRP and this could probably be responsible for increased CVS risk in PD patients.

Author Biography

Zbigniew Heleniak, Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdansk, Gdańsk, Poland
no

References

References

El-Mesallamy HO, Abdel Hamid SG, Gad MZ. Oxidative stress and asymmetric dimethylarginine are associated with cardiovascular complications in hemodialysis patients: improvements by L-arginine intake. Kidney Blood Press Res. 2008; 31(3):189-195.

Lim CT, Yap XH, Chung KJ, Khalid MA, Yayha N, Latiff LA, Goh BLPredictor of cardiovascular risks in end stage renal failure patients on maintenance dialysis.Pak J Med Sci. 2015;31(6):1300-5. doi: 10.12669/pjms.316.8039.

Zoccali C, Enia G, Tripepi G, Panuccio V, Mallamaci F. Clinical epidemiology of major non-traditional risk factors in peritoneal dialysis patients. Perit Dial Int. 2005 Feb;25 Suppl 3: S84-7.

Wiecek A, Kokot F, Chudek J, Adamczak M. The adipose tissue--a novel endocrine organ of interest to the nephrologist. Nephrol Dial Transplant. 2002 Feb;17(2):191-5.

Fouque D, Kalantar-Zadeh K, Kopple J, Cano N, Chauveau P, Cuppari L, Franch H, Guarnieri G, Ikizler TA, Kaysen G, Lindholm B, Massy Z, Mitch W, Pineda E, Stenvinkel P, Treviño-Becerra A, Wanner C.A proposed nomenclature and diagnostic criteria for protein-energy wasting in acute and chronic kidney disease.Kidney Int. 2008 Feb;73(4):391-8. Epub 2007 Dec 19. Erratum in: Kidney Int. 2008 Aug;74(3):393.

Steiber AL, Kalantar-Zadeh K, Secker D et al: Subjective global assessment in chronic kidney disease: A Review. J Ren Nutr 2004 (4); 14:191-200.

Bogacka A, Sobczak-Czynsz A, Kucharska E, Madaj M, Stucka K.Analysis of nutrition and nutritional status of haemodialysis patients Rocz Panstw Zakl Hig. 2018;69(2):165-174.

Balafa O, Halbesma N, Struijk DG, Dekker FW, Krediet RT.Peritoneal albumin and protein losses do not predict outcome in peritoneal dialysis patients.Clin J Am Soc Nephrol. 2011 Mar;6(3):561-6. doi: 10.2215/CJN.05540610. Epub 2010 Nov 11.

Guebre-Egziabher F. Drai J. Fouque D. Adiponectin and chronic kidney disease. J Ren Nutr. 2007.17(1):9-12.

Young V, Balaam S, Orazio L, Bates A, Badve SV, Johnson DW, Campbell KL.APPETITE PREDICTS INTAKE AND NUTRITIONAL STATUS IN PATIENTS RECEIVING PERITONEAL DIALYSIS.J Ren Care. 2016 Jun;42(2):123-31. doi: 10.1111/jorc.12156.

Alves FC, Sun J, Qureshi AR, Dai L, Snaedal S, Bárány P, Heimbürger O, Lindholm B, Stenvinkel P.The higher mortality associated with low serum albumin is dependent on systemic inflammation in end-stage kidney disease.PLoS One. 2018 Jan 3;13(1):e0190410. doi: 10.1371/

Zoccali C, Bode-Boger S, Mallamaci F, et al. Plasma concentration of asymmetrical dimethylarginine and mortality in patients with end-stage renal disease: a prospective study. Lancet 2001, 358(9299):2113–2117.

Zhao JR, Zhang DY, Sun DZ. Correlation research on ADMA plasma levels and left ventricular function of peritoneal dialysis patients.Int J Clin Exp Med. 2014 Nov 15;7(11):4455-60. eCollection 2014.

Ravani P, Tripepi G, Malberti F, et al. Asymmetrical dimethylarginine predicts progression to dialysis and death in patients with chronic kidney disease: a competing risks modeling approach. J AmSoc Nephrol 2005, 16(8):2449–2455

.Aucella F, Maas R, Vigilante M, et al. Methylarginines and mortality in patients with end stage renal disease: a prospective cohort study. Atherosclerosis 2009, 207(2):541–545.

Tripepi G, Raso FM, Sijbrands E, et al. Inflammation and Asymmetric Dimethylarginine for Predicting Death and Cardiovascular Events in ESRD Patients. Clin J Am Soc Nephrol. 2011; 6: 1714-1721.

Schepers E, Barreto DV, Liabeuf S, et al. Symmetric Dimethylarginine as a Proinflammatory Agent in Chronic Kidney Disease Clin J Am Soc Nephrol. 2011; 6: 2374 -2383.

Xu X, Tian X, Chen Y, Yang ZK, Qu Z, Dong J.ASSOCIATIONS OF ADIPONECTIN, LEPTIN LEVELS, AND THE CHANGE OF BODY COMPOSITION IN PATIENTS ON PERITONEAL DIALYSIS: A PROSPECTIVE COHORT STUDY.Perit Dial Int. 2018 Apr 19. pii: pdi.2017.00177. doi: 10.3747/pdi.2017.00177. [Epub ahead of print]

Silha JV, Krsek M, Skrha JV et al. Plasma resistin, adiponectin and leptin levels in lean and obese subjects: correlations with insulin resistance. Eur J Endocrinol 2003;149:331-335.

Scholze A. Tepel M. Role of leptin in reverse epidemiology in chronic kidney disease. Semin Dial. 2007;20(6):534-8.

Lam MF, Leung JC, Lo WK et al. KN. Hyperleptinaemia and chronic inflammation after peritonitis predicts poor nutritional status and mortality in patients on peritoneal dialysis. Nephrol Dial Transplant. 2007 May;22(5):1445-50.

Mak RH, Cheung W, Cone RD, Marks DL: Leptin and inflammation-associated cachexia in chronic kidney disease. Kidney Int 2006;69:794-797.

Małgorzewicz S, Lichodziejewska-Niemierko M, Aleksandrowicz-Wrona E, Świetlik D, Rutkowski B, Łysiak-Szydłowska W. Adipokines, endothelial dysfunction and nutritional status in peritoneal dialysis patients. Scand J Urol Nephrol. 2010 Dec;44(6):445-5.

Delgado C, Chertow GM, Kaysen GA, Dalrymple LS, Kornak J, Grimes B, Johansen KL.Associations of Body Mass Index and Body Fat With Markers of Inflammation and Nutrition Among Patients Receiving Hemodialysis.Am J Kidney Dis. 2017 Dec;70(6):817-825. doi: 10.1053/j.ajkd.2017.06.028.

Published
2018-12-03
Section
Articles