ABSTRACT
The upsurge in the renal failure patients undergoing haemodyalisis has attracted the researcher to figure out the possible mechanism of the haemodyalysis associated with hypotension. the purpose of this study was to determine plasma levels of ghrelin, leptin, insulin, and nitric oxide in renal failure patients with and without haemodialysis-induced hypotension, and to examine the potential correlation between these parameters and mean blood pressure in those patients. Sixty-four renal patients were included in the study and, were divided into three groups The first group consisted of 21 patients with renal insufficiency who were not on dialysis [NHD], the second group consisted of 23 patients on regular maintenance hemodialysis with normal blood pressure [HDNT] and, the third group consisted of 20 patients on regular maintenance hemodialysis with hypotension [HDHT]. The control group consisted of 20 healthy volunteers. Body mass index [BMI] and waist-hip ratio [WHR] were assessed. Blood pressure was measured three times within an interval of 5 min and the average was estimated. Mean blood pressure [MBP] was calculated. Nitric oxide metabolites [nitrates + nitrites, NO[X]], plasma ghrelin, leptin and insulin levels were assayed. BMI was significantly lower in HDHT group than the control, NHD, and HDNT groups. While the waist/hip ratio was significantly higher in HDHT group than NDH group. Both systolic and diastolic blood pressures were significantly lower in HDHT group than the other groups. Regarding the HDNT group, the systolic blood pressure was significantly lower than control and NHD group, while the diastolic one was significantly lower than the NDH group. Serum albumin was significantly lower in both HDHT and HDNT groups compared with NHD and control groups, however, it was significantly lower in HDHT compared with HDNT group. In addition, serum urea and creatinine, were significantly higher in the both HDHT, and HDNT groups compared with NHD and control groups, and it was significantly lower in HDHT compared with HDNT group. Plasma levels of Ghrelin, nitrate/nitrite [NO[X]] and leptin were significantly higher in patients compared with the control groups. Moreover, they were significantly higher in HDHT than HDNT and NHD groups, and in HDNT than NHD group. Regarding plasma levels of insulin it was significantly higher in the renal patients compared with the control group. However, there was no significant difference in insulin level between NHD and DHNT groups, while it was significantly higher in HDHT group compared with the two other renal patient groups [NHD, and HDNT. There was a significant negative correlation between changes of mean artrial blood pressure and ghrelin, leptin, insulin levels in both HDNT and HDHT patients. Our data suggest that excessive production of ghrelin, leptin, insulin and NOX contributes to HD-related hypotension in renal dialysis patients. The significantly elevated plasma levels of leptin and ghrelin is probably, at least in part, caused by impairment of their clearance by the kidney. Although being produced by the kidney, the physiological role of ghrelin in the kidney under normal and pathological conditions remains not fully elucidated. The elevated plasma insulin level may be caused by impaired glucose metabolism in uremic patients with alterations in insulin degradation and insulin secretion. The elevated NO[X] may be due to elevated serum leptin that modulates endothelial NO production, and /or elevated serum insulin that enhances NO release. However, we need to study the correlation between NO production and leptin and insulin levels in HD-related hypotension in renal dialysis patients to confirm this hypothesis