Relation of parathyroid hormone with malnutrition in peritoneal dialysis patients

Aims: Protein-energy wasting syndrome is a risk factor specific to ESRD is protein-energy wasting (PEW) syndrome. Clinical and experimental studies have suggested that secondary hyperparathyroidism plays a vital role in increasing energy expenditure in patients with ESRD. The geriatric nutritional risk index (GNRI) is used to evaluate nutritional status in various pathological conditions. Considering the effect of parathormone on malnutrition and studies indicating that parathyroid hormone causes weight loss, we aimed to investigate the relationship between malnutrition and parathyroid hormone (PTH) in our patients using GNRI. Methods: Forty-nine patients without known malignancy, liver disease, or chronic inflammatory disease who underwent peritoneal dialysis were included in the study. Patient data were recorded from these files. Height and weight were measured. GNRI was calculated by the formula 14.89 × serum albumin (g/dL) + [41.7 × bodyweight/ideal body weight Results: Forty-nine patients (29 females, 59.2%) were included in the study. Three (6.1%), seven (14.3%), and seven (14.3%) patients had severe, moderate, and mild malnutrition, respectively. GNRI was positively correlated with albumin, hematocrit, and calcium levels (r=0.757, r=0.355, r=0.423; p<0.05, respectively). GNRI was negatively correlated with dialysis vintage (r=-0.303, p=0.038) and PTH (r=-0.287; p=0.046). Conclusion: This study demonstrated a relationship between malnutrition and hyperparathyroidism. Increased PTH levels may cause phenotypic switching from white to brown fat via PTH receptors.

Keywords:

Peritoneal dialysis protein-energy malnutrition, secondary hyperparathyroidism,

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Goodkin DA, Bragg-Gresham JL, Koenig KG, et al. Association of comorbid conditions and mortality in hemodialysis patients in Europe, Japan, and the United States: The Dialysis Outcomes and Practice Patterns Study (DOPPS). J Am Soc Nephrol. 2003;14(12):3270–3277.
Fouque D, Kalantar-Zadeh K, Kopple J, et al. A proposed nomenclature and diagnostic criteria for protein-energy wasting in acute and chronic kidney disease. Kidney Int. 2008;73(4):391–398.
Carrero JJ, Stenvinkel P, Cuppari L, et al. Etiology of the protein-energy wasting syndrome in chronic kidney disease: a consensus statement from the International Society of Renal Nutrition and Metabolism (ISRNM). J Ren Nutr. 2013;23(2):77–90.
Ikizler TA, Cano NJ, Franch H, et al. Prevention and treatment of protein energy wasting in chronic kidney disease patients:a consensus statement by the International Society of Renal Nutrition and Metabolism. Kidney Int. 2013;84(6):1096–1107.
Pifer T, Mccullough K, Port F, et al. Mortality risk in hemodialysis patients and changes in nutritional indicators: DOPPS. Kidney Int. 2002;62(6):2238–2245.
Kalantar-Zadeh K, Supasyndh O, Lehn RS, McAllister CJ, Kopple JD. Normalized protein nitrogen appearance is correlated with hospitalization and mortality in hemodialysis patients with kt/v greater than 1.20. J Ren Nutr. 2003;13(1):15–25.
Pupim LB, Caglar K, Hakim RM, Shyr Y, Ikizler TA. Uremic malnutrition is a predictor of death independent of inflammatory status. Kidney Int. 2004;66(5):2054–2060.
Cuppari L, de Carvalho AB, Avesani CM, Kamimura MA, Dos Santos Lobão RR, Draibe SA. Increased resting energy expenditure in hemodialysis patients with severe hyperparathyroidism. J Am Soc Nephrol. 2004;15(11):2933–2939.
Chou FF, Lee CH, Chen JB. General weakness as an indication for parathyroid surgery in patients with secondary hyperparathyroidism. Arch Surg. 1999;134:1108–1111.
Kir S, Komaba H, Garcia AP, et al. PTH/PTHrP receptor mediates cachexia in models of kidney failure and cancer. Cell Metab. 2016;23(2):315–323.
Bouillanne O, Morineau G, Dupont C, et al. Geriatric nutritional risk index: a new index for evaluating at-risk elderly medical patients. Am J Clin Nutr. 2005;82(4):777–783
Yamada K, Furuya R, Takita T, et al. Simplified nutritional screening tools for patients on maintenance hemodialysis. Am J Clin Nutr. 2008;87(1):106–113.
Xiong J, Wang M, Zhang Y, et al. Association of geriatric nutritional risk index with mortality in hemodialysis patients: a meta-analysis of cohort studies. Kidney Blood Press Res. 2018;43(6):1878–1889.
Kobayashi I, Ishimura E, Kato Y, et al. Geriatric nutritional risk index, a simplified nutritional screening index, is a significant predictor of mortality in chronic dialysis patients. Nephrol Dial Transplant. 2010;25(10):3361–3365.
Park JH, Bin Kim S, Shin HS, Jung YS, Rim H. Geriatric nutritional risk index may be a significant predictor of mortality in Korean hemodialysis patients: a single center study. Ther Apher Dial. 2012;16(2):121–126.
Panichi V, Cupisti A, Rosati A, et al. Geriatric nutritional risk index is a strong predictor of mortality in hemodialysis patients:data from the Riscavid cohort. J Nephrol. 2014;27(2):193–201.
Takahashi H, Ito Y, Ishii H, et al. Geriatric nutritional risk index accurately predicts cardiovascular mortality in incident hemodialysis patients. J Cardiol. 2014;64(1):32–36.
Nakagawa N, Matsuki M, Yao N, et al. Impact of metabolic disturbances and malnutrition-inflammation on 6-year mortality in Japanese patients undergoing hemodialysis. Ther Apher Dial. 2015;19(1):30–39.
Ishii H, Takahashi H, Ito Y, et al. The association of ankle brachial index, protein-energy wasting, and inflammation status with cardiovascular mortality in patients on chronic hemodialysis. Nutrients. 2017;9(4):416.
Matsukuma Y, Tanaka S, Taniguchi M, et al. Association of geriatric nutritional risk index with infection-related mortality in patients undergoing hemodialysis: the Q-cohort study. Clin Nutr. 2019;38(1):279–287.
Yamada S, Yamamoto S, Fukuma S, Nakano T, Tsuruya K, Inaba M. Geriatric nutritional risk index (GNRI) and creatinine index equally predict the risk of mortality in hemodialysis patients:J-DOPPS. Sci Rep. 2020;10(1):5756.
Szeto C-C, Kwan BC-H, Chow K-M, Law M-C, Li PK-T. Geriatric nutritional risk index as a screening tool for malnutrition in patients on chronic peritoneal dialysis. J Ren Nutr. 2010;20(1):29–37.
Kang SH, Cho KH, Park JW, Yoon KW, Do JY. Geriatric nutritional risk index as a prognostic factor in peritoneal dialysis patients. Perit Dial Int. 2013;33(4):405–410
Ren M, Sheng Q, Xie X, Zhang X, Han F, Chen J. Geriatric nutritional risk index is associated with mortality in peritoneal dialysis patients. Intern Med J. 2020;50(4):470–476.
Shafi T, Jaar BG, Plantinga LC. Association of residual urine output with mortality, quality of life, and inflammation in incident hemodialysis patients:the Choices for Healthy Outcomes in Caring for End-Stage Renal Disease (CHOICE) study. Am J Kidney Dis. 2010;56(2):348–358.
Wang AY. Preserving residual kidney function in hemodialysis patients-back in the spotlight. J Am Soc Nephrol. 2016;27(12):3504–3507.
Tsuruya K, Eriguchi M, Yamada S, Hirakata H, KitazonoT. Cardio-renal syndrome in end-stage kidney disease. Blood Purif. 2015;40(4):337–343.
Avesani CM, Carrero JJ, Axelsson J. Inflammation and wasting in chronic kidney disease. Kidney Int. 2006;104(Suppl):8–13.
Stenvinkel P, Lindholm B, Heimbürger O. Novel approaches in an integrated therapy of inflammatory-associated wasting in end stage renal disease. Semin Dial. 2004;17(6):505–515.
Heimbürger O, Qureshi AR, Blaner WS. Hand-grip muscle strength, lean body mass and plasma proteins as markers of nutritional status in patients with chronic renal failure close to start of dialysis therapy. Am J Kidney Dis. 2000;36(6):1213–1225.
Ikizler TA, Wingard RL, Sun M, Harvell J, Parker RA, Hakim RM. Increased energy expenditure in hemodialysis patients. J Am Soc Nephrol. 1996;7(12):2646–2653.
Wu J, Boström P, Sparks LM, et al. Beige adipocytes are a distinct type of thermo genic fat cell in mouse and human. Cell. 2012;150(2):366–376.
Kir S, White JP, Kleiner S, et al. Tumour-derived PTH related protein triggers adipose tissue browning and cancer cachexia. Nature. 2014;513(7516):100–104.