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Published on: July 19, 2018
Plasma ghrelin levels are associated with coronary microvascular and endothelial dysfunction in peritoneal dialysis
Yasar Caliskan1, Numan Gorgulu, Berna Yelken
1Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey. ykcaliskan@yahoo.com
Insights
Lower plasma ghrelin levels are linked to endothelial dysfunction in peritoneal dialysis patients. This suggests ghrelin may play a role in preventing atherosclerosis development in this population.
Area of Science:
- Cardiovascular Medicine
- Nephrology
- Endocrinology
Background:
- Cardiovascular disease is a leading cause of mortality in peritoneal dialysis (PD) patients.
- Endothelial dysfunction (ED) is an early indicator of vascular pathology and a risk factor for cardiovascular events.
- Ghrelin and leptin are peptide hormones with known cardiovascular effects, but their role in PD-associated vascular dysfunction is not fully understood.
Purpose of the Study:
- To investigate the association between plasma ghrelin and leptin levels and coronary microvascular and endothelial function in PD patients.
- To determine if ghrelin or leptin levels correlate with markers of endothelial dysfunction in this cohort.
Main Methods:
- A cross-sectional study involving 24 non-diabetic PD patients (age 18-70).
- Plasma ghrelin and leptin concentrations were measured.
- Coronary microvascular function was assessed using coronary flow reserve (CFR) via transthoracic Doppler echocardiography, with CFR < 2 indicating ED.
Main Results:
- Patients with preserved coronary flow reserve (CFR ≥ 2) had significantly higher plasma ghrelin levels compared to those with ED (CFR < 2) (129.4 ± 82.1 pg/mL vs. 63.3 ± 35.8 pg/mL, p=0.03).
- No significant difference in plasma leptin levels was observed between patients with and without ED.
- Plasma ghrelin levels did not correlate with age, BMI, dialysis duration, blood pressure, ejection fraction, or leptin levels.
Conclusions:
- Decreased plasma ghrelin levels may be associated with endothelial dysfunction in PD patients.
- Reduced ghrelin may contribute to the development of atherosclerosis in PD patients through its effects on endothelial function.
- Further research is warranted to explore ghrelin's therapeutic potential in mitigating cardiovascular risk in PD patients.
Abstract:
Cardiovascular (CV) disease is the main cause of death in peritoneal dialysis (PD) patients, and endothelial dysfunction (ED) is an early sign of vascular pathology. Ghrelin, a gastric peptide with CV actions, has been shown to inhibit proatherogenic changes in experimental models. However, another peptide hormone, leptin, may mediate deleterious effects on the CV system. The aim of this study is to evaluate the relationship between plasma ghrelin and leptin levels, and their association with coronary microvascular and endothelial functions in PD patients. Twenty-four (14 females and 10 males; mean age 44 +/- 12 yr) nondiabetic PD patients, between 18 and 70 years of age, were enrolled. In addition to demographic, clinical, and laboratory parameters, plasma concentrations of ghrelin and leptin were evaluated. Endothelial functions of the coronary arteries were determined by coronary flow reserve (CFR) measurement using transthoracic Doppler echocardiography (TTDE). A CFR value of < 2 was used as an evidence for ED. When the study group was divided according to CFR measurements as CFR < 2 and >or= 2, there were no significant differences considering age, gender, etiology of renal disease, body mass index (BMI), duration of dialysis, PD modality, PD solution type, history of peritonitis, mean arterial pressure, ejection fraction, and biochemical parameters between the two subgroups. Plasma ghrelin levels (129.4 +/- 82.1 pg/mL) in patients with CFR >or= 2 were significantly higher than those in patients with CFR< 2 (63.3 +/- 35.8 pg/mL) (p = 0.03). However, no significant differences in plasma leptin levels were found between these groups [31.39 +/- 37.81 ng/mL vs. 63.95 +/- 72.83 ng/mL (p = 0.28)]. No correlation existed between plasma ghrelin levels and age, BMI, duration of dialysis, mean arterial pressure, ejection fraction, plasma leptin levels, and biochemical parameters. Decreased plasma ghrelin levels may contribute to the development of atherosclerosis in PD patients by causing ED.
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