Comparison of nutritional and inflammatory markers in dialysis patients with reduced appetite

Abstract

Background: Anorexia is common in chronic kidney disease and worsens as the disease progresses. Sex hormones and inflammatory cytokines may be related to feeding behavior. Objective: We hypothesized that appetite would be related to inflammation and outcome in hemodialysis patients but that sex may account for differences in the symptoms associated with poor appetite. Design: A cross-sectional study was conducted in patients undergoing prevalent hemodialysis (n ҃ 223; 127 M; x Ȁ SD age: 66 Ȁ 14 y). Anthropometric markers of body composition, handgrip strength, and nutritional and inflammatory status were measured, and 3 groups according to their self-reported appetite were established. Overall mortality was assessed after 19 mo (range: 2-29 mo) of follow-up. Results: Poor appetite was associated with a longer vintage time, increased inflammation (higher serum concentrations of interleukin 6 and C-reactive protein), and a worse nutritional status (lower serum concentrations of insulin-like growth factor I, albumin, urea, and creatinine). However, across worsening appetite scale, handgrip strength was incrementally lower in men but not in women (multivariate analysis of variance). In a multivariate logistic regression analysis (pseudo r 2 ҃ 0.19), appetite loss was associated with sex [odds ratio (OR): 0.41; 95% CI: 0.24, 0.72], insulin-like growth factor I (3.58; 2.10, 6.32), and C-reactive protein 10 mg/L (2.39; 1.34, 4.11). Finally, appetite loss was associated with worse clinical outcome even after adjustment for age, sex, inflammation, dialysis vintage, and comorbidity (likelihood ratio ҃ 44.3; P 0.0001). Conclusions: These results show a close association among appetite, malnutrition, inflammation, and outcome in patients undergoing prevalent hemodialysis. Moreover, our data suggest that uremic men may be more susceptible than are women to inflammation-induced anorexia.Am J Clin Nutr 2007;85:695-701.

IL-6 Levels, Nutritional Status, and Mortality in Prevalent Hemodialysis Patients

“…Given the estimates of the regression coefficients in Table 2, it would appear that patients with increased IL-6 levels had a significantly lower daily energy intake over the duration of the study. KalantarZadeh et al (22) and Carrero et al (23) showed that the extent of anorexia is closely and directly related to the level of plasma proinflammatory cytokine concentrations, including IL-6. Similar associations between dietary intake and Numbers of surviving patients versus those who died during follow-up at each study visit are given in parentheses.…”

“…Moreover, several investigators suggested that PEW is a consequence of chronic inflammatory processes in patients with renal insufficiency (14,15,17,18). The pathophysiological basis of inflammatory cytokines, and particularly of IL-6-induced PEW, may be increased protein catabolism (19,20) and/or resistance to the anabolic effect of growth hormone, which may contribute to the loss of strength and muscle mass (21); in addition, inflammation may affect appetite and eating behavior (22,23). It was recently suggested that interactions between inflammatory markers and sTWEAK (soluble TNF-like weak inducer of apoptosis) affect the nutritional status of prevalent HD patients; thus, significant reductions in markers of PEW (IGF-1 and handgrip strength) associated with high levels of both IL-6 and sTWEAK may provide an additional link between inflammation and PEW (24).…”

Baseline Levels and Trimestral Variation of Triiodothyronine and Thyroxine and Their Association with Mortality in Maintenance Hemodialysis Patients

“…This is a post hoc analysis from a cohort of prevalent HD patients in the Stockholm region, described elsewhere in more detail (20,21). The inclusion period ranged from October 2003 until September 2004.…”

Obesity in CKD—What Should Nephrologists Know?

“…93 In addition, although obesity can be associated with muscle wasting and catabolism, 11 increased fat stores usually reflect well preserved energy stores and preserved appetite. 94 In this case, the overall protective nutritional effect presumably overrides the cumulative longterm metabolic adverse effects of obesity. Despite overwhelming epidemiologic data on this association, we believe that a generalization of this sort would actually be inappropriate, and additional consideration of certain phenotypic features is necessary for proper management of dialysis patients.…”