Comparison of Markers of Appetite and Inflammation Between Hemodialysis Patients With and Without Failed Renal Transplants

Objective: The survival of patients returning to hemodialysis (HD) following kidney transplant failure is unfavorable. However, the factors responsible for this poor outcome are largely unknown; chronic inflammation due to failed allograft and malnutrition may contribute to morbidity and mortality. We aim to compare the markers of appetite and malnutrition, and their relation with inflammation in HD patients with and without previous kidney transplantation. Methods: Fifty-six patients with failed renal allografts at least 3 months on dialysis (31 men, 25 women; mean age, 46 +/- 9 years) and 77 HD patients who never underwent a transplant (43 men, 34 women; mean age, 50 +/- 15 years) were included in the study. The appetite and diet assessment tool (ADAT) was used to determine the self reported appetite of patients. Serum concentrations of ghrelin, leptin, insulin like growth factor 1 (IGF-1), interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-alpha), and high-sensitivity C-reactive protein (hs-CRP) were measured. Associations among these variables were analyzed. Results: There were no significant differences considering age, gender or duration of renal replacement therapy between the 2 groups. The scores from Appetite and Diet Assessment Tool were significantly higher in the failed-transplant group. Serum ghrelin levels were significantly higher and serum albumin levels were significantly lower in the failed-transplant group. Serum leptin levels were similar between 2 groups. In addition, hs-CRP, IL-6, and TNF- alpha levels, which were used as inflammatory parameters, were significantly higher in the failed-transplant group. Conclusions: Elevated serum ghrelin levels and inflammation may cause diminished appetite and malnutrition in patients with failed renal allografts, and higher levels of this hormone seem to be associated with inflammation caused by retained failed allografts. (C) 2012 by the National Kidney Foundation, Inc. All rights reserved.