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Kidney Week

Abstract: SA-PO819

Effects of Anti-Inflammatory and Insulin Sensitizing Agents on Markers of Inflammation and Protein Turnover in Maintenance Hemodialysis (MHD) Patients

Session Information

Category: Health Maintenance, Nutrition, and Metabolism

  • 1300 Health Maintenance, Nutrition, and Metabolism

Authors

  • Alsouqi, Aseel, Vanderbilt University Medical Center, Nashville, Tennessee, United States
  • Deger, Serpil muge, Vanderbilt University Faculty of Medicine Department of Nephrology, Nashville, Tennessee, United States
  • Hung, Adriana, VA & Vanderbilt University, Nashville, Tennessee, United States
  • Siew, Edward D., Vanderbilt University School of Medicine, Nashville, Tennessee, United States
  • Ikizler, Talat Alp, Vanderbilt University Medical Center, Nashville, Tennessee, United States
Background

Systemic inflammation and insulin resistance are associated with increased protein catabolism leading to protein energy wasting in MHD patients.

Methods

We studied the metabolic effects of a PPAR-gamma agonist (pioglitazone-TZD 30 mg daily, N=9) and an Interleukin-1 receptor antagonist (anakinra subcutaneous injections 3 times weekly during hemodialysis, N=7) versus placebo (n=8) over 3 months in MHD patients through a randomized placebo-controlled trial. Whole body and skeletal muscle protein turnover, inflammatory markers and body composition were measured at baseline and 12 weeks after intervention in all patients (Total N = 24). The primary outcome was change in whole-body protein balance (WBPB) measured by stable isotope technique. Inflammatory markers and lean body mass (LBM) were secondary outcomes.

Results

There were no significant demographic or clinical differences at baseline between groups. There were no statistically significant differences in whole-body protein balance between groups over 3 months (Table 1). Patients in the pioglitazone group demonstrated a significant decline in HsCRP concentrations compared to placebo (p= 0.03), but there were no statistically difference in changes in IL-6 for either group. There were no statistically significant differences between groups regarding changes in lean body mass or fat mass in any of the study groups.

Conclusion

In this pilot mechanistic trial, we were not able to demonstrate a significant change in whole body protein balance and lean body mass with 3-month administration of anakinra or pioglitazone in MHD patients. While these results indicate a lack of efficacy of the anti-inflammatory and insulin sensitizing interventions tested in this study, our analyses could be limited by relatively small number of subjects and duration of intervention.

Median and IQR values for baseline and after 8 weeks of intervention.

Funding

  • NIDDK Support