Ghrelin and Obestatin in CKD Children
Condition: Chronic Kidney Diseases
MeSH terms: Kidney Diseases; Renal Insufficiency, Chronic
Study type: Observational

Summary: 
      Protein energy wasting (PEW) is a complex syndrome associated with different underlying
      illnesses and characterized by loss of muscle, with or without loss of fat. It is a highly
      prevalent condition among patients with chronic kidney disease (CKD), associated with
      increased morbidity and mortality.

      The pathophysiology of PEW in CKD is multifactorial and not yet completely understood. The
      potential role in uremic PEW of two of hormones involved in orexigenic/anorexigenic balance,
      ghrelin and obestatin, both derived from the ghrelin gene (GHRL), has been investigated in
      adults and, less extensively, in children. Aim of our study was to measure AG, UAG and
      obestatin concentrations in children with CKD and to assess their potential contribution to
      the development of pediatric uremic PEW.
    

Detailed description: 
      This is a cross-sectional case-control study. Between January 2013 and June 2015 children and
      adolescents aged 5-20 years, referred to the Pediatric Nephrology, Dialysis and Transplant
      Unit of Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico - Milan, Italy were
      enrolled. Subjects with CKD stages II-V under conservative treatment (CKD-CT), or undergoing
      hemodialysis treatment (CKD-HD), or being renal transplant recipients (RTx) were included in
      the study. Data about age, primary renal disease and concomitant medications were collected
      for each subject.

      CKD stages were defined using the K/DOQI criteria of the US National Kidney Foundation.

      Control subjects were outpatients of the Pediatric Surgery Unit of the Fondazione IRCCS Ca'
      Granda - Ospedale Maggiore Policlinico - Milan, Italy, aged 1-20 years, who underwent a blood
      sample collection before a surgical intervention for the treatment of minor diseases that did
      not impair renal or endocrine function (i.e. phimosis, hydrocele, inguinal hernia).

      Biochemical and hormonal parameters Blood samples were collected between 7:00 and 8:00 a.m.
      after an overnight fast, and before dialysis in CKD-HD patients. Routine biochemical
      parameters [creatinine, urea] were measured in all subjects. Glomerular filtration rate was
      estimated (eGFR) by the Schwartz formula, with k = 0.413, as appropriate for standardized
      creatinine.

      In all subjects, plasma AG and UAG concentrations were measured by the Human Acylated /
      Unacylated Ghrelin ELISA kit (BioVendor, Laboratorni Medicina a.s., Brno, Czech Republic)
      according to manufacture procedures, and AG/UAG ratio was calculated. Serum obestatin
      concentrations were determined using the Human Obestatin ELISA kit (BioVendor, Laboratorni
      Medicina a.s., Brno, Czech Republic).
    

Intervention name(s): none intervention
Intervention type(s): Other
Intervention description(s): it is not an interventional study; it is an observational study
Observational model: Cohort
Time perspective: Cross-Sectional
Sampling method: Probability Sample
Study population: 
        A total of 154 subjects were included (M:F=100:54), 111 patients and 43 controls. Out of
        111 patients, 43 had CKD stages II-V under conservative treatment (CKD-CT), 20 were on
        hemodialysis (CKD-HD), 48 were renal transplant recipients (RTx).
      
Keywords: ghrelin; obestatin; children