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Aim: Malnutrition and inflammation are involved in the pathogenesis of atherosclerosis and increased risk of cardiovascular diseases in end-stage renal disease. The aim of this study was to assess the relationship between concentrations of plasma adiponectin, serum C-reactive protein (CRP), carotid intima-media thickness (IMT) and duration of haemodialysis (HD) treatment in prevalent HD patients. Methods: Plasma adiponectin and serum CRP concentrations were estimated in 80 HD patients and 22 healthy controls. Carotid IMT was measured by ultrasound technique. HD patients were followed up for 23 ± 16 months. During this period, 24 of them died. Results: In HD patients, plasma adiponectin concentration was over 3 times higher than in controls (29.0 ± 2.1 vs. 8.7 ± 2.6 µg/ml; p < 0.001). HD patients with serum CRP concentrations ≧5 mg/l were characterized by a lower plasma adiponectin concentration than HD patients with the CRP <5 mg/l (23.9 ± 3.5 vs. 33.0 ± 3.1 µg/ml; p = 0.03). Plasma adiponectin and serum CRP concentrations were inversely related in HD (τ = –0.181; p = 0.02). No relationship between adiponectinaemia and IMT was observed. Survival (Kaplan-Meier analysis) within the lowest plasma adiponectin tertile tended (p = 0.06) to be the worse. Conclusions: (1) Inflammatory processes are associated with an inadequate low plasma adiponetin concentration in HD patients, and (2) a lower plasma adiponectin concentration seems to be a new predictor of poor outcome in HD patients.

INTROduCTION Ghrelin is a hormone produced mainly by the stomach, which enhances gastric emptying. The disturbances of ghrelin secretion and/or bio degradation may play an important role in the pathogenesis of gastroparesis in hemo dialysis patients, especially those with diabetic neph ropathy. ObjECTIvEs The aim of the study was to assess postprandial changes in plasma ghrelin in hemo dialysis patients with diabetic or nondiabetic nephropathy. PATIENTs ANd mEThOds Thirtytwo hemo dialysis patients (16 with diabetic nephropathy [HDDM], 16 with nondiabetic nephropathies [HD]) and 15 healthy subjects (C) were enrolled into the study. Plasma ghrelin concentrations were assessed in the fasting state and at 30, 60 and 120 min after ingestion of a test meal. Gastric emptying was assessed based on changes in serum para cetamol concentrations ingested with the meal. REsuLTs In both HD groups fasting plasma ghrelin levels were significantly higher than in C. After ingestion of a test meal plasma ghrelin levels declined mostly at 60 min. In contrast to C, decreased ghrelinemia persisted over 120 min after ingestion of a test meal in both hemodialysis groups. There was no correlation between postprandial reduction in plasma ghrelin at 60 and 120 min and serum para cetamol concentration in HD and HDDM, while in C decrease in postprandial plasma ghrelin at 60 min correlated with serum para cetamol concentrations. CONCLusIONs In hemo dialysis patients plasma ghrelin levels are significantly elevated compared to healthy subjects. Prolonged postprandial suppression of ghrelin secretion may contribute to the pathogenesis of gastric emptying disorders in hemo dialysis patients. Abnormal postprandial ghre linemia was observed especially in patients with diabetic nephropathy.

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