The correlation between agouti-related peptide level and clinic, anthropometric measurements and cytokines in patients with chronic renal failure and protein energy wasting syndrome

Introduction, aim: Cardiovascular diseases are the most important causes of mortality in patients with chronic kidney disease. Protein energy wasting syndrome, an advanced form of malnutrition, has contributed to this accelerated mortality. Anorexia, the imbalance of hormones which regulate appetite, inflammation, dialysis, the incresed resting energy expenditure, hormonal derangement such as insulin resistance and vitamin D deficiency, metabolic acidosis, decreased anabolism, decreased physical activity and comorbidities, have caused the development of protein energy wasting syndrome in patients with chronic kidney disease. The aim of our study is to evaluate the correalation between the level of agouti-related peptide which increase apetite and clinic, anthropometric measurements and cytokines in patients with chronic renal failure and protein energy wasting syndrome. Material-methods: Seventy-six patients were included in this study. Thirty-eight patients who have three or more criteria of protein energy wasting syndrome, 27 patients who have two criteria and 11 healthy individuals created protein energy wasting syndrome group, malnutrition group, and control group respectively. The general biochemical parameters, complete blood count, IL-1, 6, TNF-α, agouti-related peptide were measured. Body mass index, daily protein intake, mid-arm muscle circumference area were calculated. Comorbidities and received drugs were enrolled. Results: Fifty-one percent of our patients had protein energy wasting syndrome criteria. Agouti-related peptide was significantly lower and TNF-α, CRP levels were significantly higher in protein energy wasting syndrome group than control group. The lowest albumin value and body mass index were identified in protein energy wasting syndrome group among the three groups. According to control group, mid-arm circumference area and dietary protein intake were significantly lower in protein energy wasting syndrome group. The positive correlation between agouti-related peptide and daily protein intake, the negative correlation between mid-arm circumference area and CRP, between albumin and TNF-α were found. There was a reduction in lean tissue index in 97% of patients in protein energy wasting syndrome group. There was no significant difference according to agouti-related peptide level between hemodialysis and peritoneal dialysis patients with protein energy wasting syndrome. Discussion: Protein energy wasting syndrome are common in patients with chronic kidney disease. The reduction of daily protein intake and the increased inflammation may contribute to the development of protein energy wasting syndrome. Agouti-related peptide level is seriously low in patients with protein energy wasting syndrome. This situation may influence daily protein intake. The approaches which increase agouti-related peptide level may reduce the risk of development of protein energy wasting syndrome.