Circulating motilin, ghrelin and GLP-1 and their correlations with gastric slow waves in patients with chronic kidney disease

Background/Aims: Patients with chronic kidney disease (CKD) commonly complain upper gastrointestinal (GI) symptoms, especially anorexia. Hemodialysis (HD) has been noted to improve GI symptoms; however, underlying mechanisms are unclear. This study was designed 1) to study effects of HD on GI symptoms and gastric slow waves; 2) to investigate possible roles of ghrelin and glucagon-like peptide-1 (GLP-1). Methods: This study recruited 13 healthy controls, 20 CKD patients without HD (CKD group) and 18 CKD patients with HD (HD group). Dyspeptic symptoms, autonomic functions, gastric slow waves, and plasma level of ghrelin and GLP-1 were analyzed. Results: 1) The CKD patients with HD showed markedly lower scores of anorexia (0.6±0.2 vs. 3.2±0.4, P<0.001) compared to patients without HD. 2) The CKD group but not HD group showed a significant reduction (25.6%) in the percentage of normal gastric slow waves, compared to controls. 3)The CKD group exhibited a significantly lower ghrelin level compared to the HD group (26.8±0.9ng/L vs. 34.1±2.3ng/L, P<0.02) and a higher GLP-1 level(29.4±2.8 pmol/L vs. 20.0±2.1pmol/L, P<0.05) compared to controls. Moreover, the percentage of normal slow waves was positively correlated with ghrelin (r=0.385, P=0.019) but negatively correlated with GLP-1 (r=-0.558, P<0.001) in all CKD patients. Conclusions: Hemodialysis improves upper GI symptoms and gastric slow waves in CKD patients. An increase in ghrelin and a decrease in GLP-1 might be involved in the HD-induced improvement in gastric slow waves.

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