The newly identified anorexigenic adipokine nesfatin-1 in hemodialysis patients: Are there associations with food intake, body composition and inflammation?

Nesfatin-1 is a recently identified anorexigenic peptide that has been implicated in appetite regulation, weight loss and/or malnutrition. Anorexia and malnutrition are common features of chronic kidney disease (CKD) that predispose patients to worse outcomes. However, the reasons for the occurrence of anorexia in CKD patients are not fully elucidated. The aim of this study was to investigate the association between nesfatin-1 and protein intake and body composition in patients undergoing hemodialysis (HD). Twenty five HD patients from a private Clinic in Rio de Janeiro, Brazil were studied and compared with 15 healthy subjects that were matched for body mass index (BMI), % body fat mass (by anthropometrics) and age. Appetite was measured using a specific questionnaire, and food intake was evaluated based on 3-day food records. Nesfatin-1 levels were measured by ELISA and leptin, TNF-α and IL-6 levels were determined by a multiplex assay kit. Serum nesfatin-1 levels did not differ between HD patients (0.16±0.07ng/mL) and healthy subjects (0.17±0.10ng/mL). Nesfatin-1 levels showed significant negative correlations with protein intake (r=-0.42; p=0.03), but did not associate with inflammatory markers or appetite scores. Combining patients and controls, we observed positive correlations with BMI (r=0.33; p=0.03), % body fat (r=0.35; p=0.03), leptin (r=0.45; p=0.006) and the triceps skinfold thickness (r=0.36; p=0.02). In multivariate analysis % body fat was the main determinant of nesfatin-1 variance. In conclusion, nesfatin-1 levels did not differ between HD patients and healthy subjects and negatively correlated with protein intake. This pathway is likely not dysregulated in uremia.

The possible role of nesfatin-1 on appetite regulation in hemodialysis patients.

Studies on appetite hormones in chronic kidney disease (CKD) patients appear of interest since these compounds may be implicated in reduced appetite, loss of weight and/or malnutrition. Anorexia seems to be related to many hormones that act in central nervous system, like leptin, obestatin and others, and more recently, was discovered a hypothalamus secreted protein that conduces to a decrease on food intake and to an increase on energetic waste, called nesfatin-1. This peptide has been studied in diabetes, mean arterial pressure and cardiovascular function, anxiety- and/or fear-related responses and inflammation, but there are no studies about a possible relationship with CKD. Therefore, considering the negative impact of anorexia and malnutrition in morbidity and mortality of CKD patients and the interest in new treatments findings for dialysis population, this review will discuss recent information about nesfatin-1 and its possible role in CKD patients.