Helicobacter Pylori Infection: A New Cause of Anorexia in Peritoneal Dialysis Patients

Abstract

♦ Objective Helicobacter pylori (HP) infection has frequently been found in dialysis patients. Chronic infections induce overproduction of pro-inflammatory substances. Inflammation has been associated with cachexia and anorexia. We explored the relationship between HP infection, anorexia, and malnutrition in peritoneal dialysis (PD) patients. ♦ Patients and Methods The study included 48 clinically stable PD patients divided into four groups: HP+ with anorexia (group I, n = 12); HP+ without anorexia (group II, n = 4); HP- with anorexia (group III, n = 5); and HP- without anorexia (group IV, n = 27). Infection with HP was diagnosed by breath test. Anorexia was evaluated using a personal interview and an eating motivation scale (VAS). The VAS included five questions that are answered before and after eating. The questions concern desire to eat, hunger, feeling of fullness, prospective consumption, and palatability. Biochemical markers of nutrition and inflammation were also determined. ♦ Results At baseline, group I showed lower scores for desire to eat, hunger sensation, prospective consumption, and palatability. They also showed lower lymphocyte counts, prealbumin, transferrin, serum albumin, normalized equivalent of protein–nitrogen appearance (nPNA), and residual renal function (RRF). In addition, the same group showed higher levels of C-reactive protein (CRP) and more sensation of fullness than the remaining groups. In the entire series, we found significant linear correlations between the following markers of nutrition and certain questions on the VAS: albumin with before-lunch desire to eat ( r = 0.38, p < 0.05), and prealbumin with before-lunch hunger ( r = 0.41, p < 0.05) and after-lunch hunger ( r = -0.35, p < 0.05). Negative linear correlations were found between albumin and fullness before lunch ( r = -0.45, p < 0.01), and between prealbumin and before-lunch desire to eat ( r = -0.39, p < 0.05). Negative linear correlations were also seen between CRP and albumin ( r = -0.35, p < 0.05) and between CRP and prealbumin ( r = -0.36, p < 0.05). Similarly, CRP showed a negative correlation with before-lunch desire to eat ( r = -0.38, p < 0.05) and after-lunch desire to eat ( r = -0.45, p < 0.01). After HP eradication, group I showed a significant increase in markers of nutrition and in VAS scores for almost all questions. Simultaneously, they showed a decrease in CRP level. Significant differences were also found in lymphocyte count (1105 ± 259.4 cells/mm3 vs 1330.8 ± 316 cells/mm3, p < 0.05), nPNA (0.9 ± 0.16 g/kg/day vs 1.07 ± 0.3 g/kg/day, p < 0.05), prealbumin (26.7 ± 6.5 mg/dL vs 33.9 ± 56.6 mg/dL, p < 0.01), albumin (3.48 ± 0.3 g/dL vs 3.67 ± 0.35 g/dL, p < 0.05), CRP (1.16 ± 1.14 mg/dL vs 0.88 ± 1.2 mg/dL, p < 0.054), before-lunch desire to eat (56.6 ± 6.8 vs 72.2 ± 4, p < 0.001), after-lunch desire to eat (5.4 ± 2.6 vs 12.3 ± 2, p < 0.01), hunger before lunch (55.4 ± 5.4 vs 73.1 ± 4.6, p < 0.001), hunger after lunch (5.8 ± 2.9 vs 11 ± 4, p < 0.01), fullness before lunch (36.6 ± 10.3 vs 18.7 ± 8.8, p < 0.001), consumption after lunch (5 ± 4.7 vs 17.5 ± 18, p < 0.05), and palatability (61 ± 5.3 vs 74.1 ± 4.1, p < 0.001). ♦ Conclusion Infection with HP is associated with anorexia, inflammation, and malnutrition in PD patients. Eradication of HP significantly improves this syndrome. Residual renal function seem to have a protective effect on appetite preservation. The present study supports the hypothesis of the involvement of inflammation in the pathogenesis of malnutrition in PD patients.

Eating Behavior Disorders in Uremia: A Question of Balance in Appetite Regulation

“…Moreover, TNF‐α can inhibit hepatic albumin gene expression (contributing to dialysis protein malnutrition) and induce systemic acidosis and muscle mass wasting with structural protein breakdown (22,50,51). Also supporting the MIA hypothesis are our findings in a group of PD patients suffering from anorexia and Helicobacter pylori infection (52). These patients showed high plasma cytokine levels and low anorexigen substances and residual renal function (RRF).…”

“…The results are measured on a scale from 0 to 100, added, and divided by five, giving a score. Values greater than 60 (before eating) are considered normal in a healthy population (52,59). The VAS has successfully been used in uremic patients (31,60,61).…”

Review of Helicobacter pylori Infection and Chronic Renal Failure

“…The gastric mucosa of approximately 50% of the world's population is infected with H. pylori, and the infection levels exceed 70% in some developing areas (14,15). Helicobacter pylori infection plays a crucial role in the development of gastrointestinal diseases, such as peptic ulcer, gastric hyperplastic polyps, gastric adenoma, gastric cancer, and gastric mucosa associated-lymphoid tissue lymphoma, both in individuals with normal renal function and in chronic renal failure patients receiving hemodialysis and CAPD (Tables 1 and 2) (4-9, 16,[18][19][20][21][22][23][24][25][26][27][28][29][30][31][32]34,[36][37][38][39][40][41][42][43][44][45][47][48][49][50][51][52][53][54][55][56][57][58][59][60].…”

“…[4][5][6][7][8][9]16,[18][19][20][21][22][23][24][25][26][27][28][29][30][31][32]34,[36][37][38][39][40][41][42][43][44][45][48][49][50][51][52][53][54][55][56][57][58][59][60], the prevalence of H. pylori infection in patients receiving chronic hemodialysis and CAPD are 43.9% ([95% CI: 42.2-45.6%], 1 435/3 272) and 34.8% ([29.6-40.2%], 113/325), respectively, which is significantly lower than in individuals with normal renal function both with and without gastrointestinal symptoms (49.8% [48.0-51.7%], 1476/2961, P < 0.001).There is variation in H. pylori infection rates among different countries. It may, therefore, be better to evaluate the infection rate in various countries.…”

Is it time to revisit residual renal function in haemodialysis? (Review Article)

“…It has been associated with preservation of appetite, increased dietary protein and caloric intake, increased lean body mass, and improved nutritional parameters including normalized protein catabolic rate, serum albumin and transferrin. 13,[26][27][28][29][30] Haemoglobin levels are higher in patients with better preserved RRF, 13,21 possibly related to higher levels of endogenous erythropoietin and consequently a decreased requirement for exogenous erythropoietin administration in these patients. 21 Higher levels of RRF may also preserve the endocrine functions of the kidneys better, including possibly higher levels of active Vitamin D metabolites.…”