Abstract: SA-PO841

The Modification Effects of Age, Inflammation, and Acyl-Ghrelin on the Relationship between Obestatin Levels and Clinical Outcomes in Maintenance Hemodialysis Patients

Session Information

Category: Dialysis

  • 606 Dialysis: Epidemiology, Outcomes, Clinical Trials - Cardiovascular

Authors

  • Beberashvili, Ilia, Assaf Harofeh Medical Center, Zerifin, Israel
  • Katkov, Anna, Assaf Harofeh Medical Center, Zerifin, Israel
  • Sinuani, Inna, Assaf Harofeh Medical Center, Zerifin, Israel
  • Azar, Ada, Assaf Harofeh Medical Center, Zerifin, Israel
  • Shapiro, Gregory, Nephrology Division Assaf Harofeh Medical Center, Zerifin, Israel
  • Feldman, Leonid, Assaf Harofeh Medical Center, Zerifin, Israel
  • Efrati, Shai, None, Zerifin, Israel
Background

Obestatin, an anorexigen, was proposed as a physiological opponent of acyl-ghrelin (AG). While obestatin failed to reproduce the anorexigenic property in further studies, experimental evidence has accumulated suggesting protective cardiovascular effects of obestatin.

Methods

To examine the hypothesis that obestatin interactions with age, AG and inflammatory markers predict outcomes of maintenance hemodialysis (MHD) population, we investigated the associations between the obestatin, acyl-ghrelin, IL-6, TNF-α, and mortality in a prospective cohort of 261 MHD patients with 6 years of follow-up. During this period 160 patients died in total, with 74 because of cardiovascular causes.

Results

For each ng/ml increase in baseline obestatin level, in fully adjusted models (including malnutrition-inflammation score, IL-6 and AG) the hazard for death from all causes was 0.90 (95% CI, 0.81 to 0.99) and for cardiovascular death 0.85 (95% CI, 0.73 to 0.99). However, these associations were more robust in subgroup of patients aged above 71 years. An interactions between high IL-6 (above median) and low obestatin (below median) levels for increased risk of all-cause mortality (synergy index 5.14, p=0.001) and cardiovascular mortality (synergy index 4.81, p=0.02) emerged in multivariable adjusted models. Interactions were observed also between obestatin, TNF-α and AG, which were associated with mortality risk. High AG and high obestatin interaction was negative (synergy index 0.76, p=0.03) in predicting lower risk for all-cause mortality and cardiovascular mortality (synergy index 0.80, p=0.008).

Conclusion

The prognostic ability of obestatin is modified by age being very prominent in patients older than 71 years. In addition, we report on novel interactions between obestatin, inflammatory mediators and AG associated with mortality risk in the study population.