Title:
Are insulin-like growth factor (IGF)-I and its’ binding proteins (IGFBP)- 1 and -3 clinically useful as markers of malnutrition, sarcopenia and inflammation in end-stage renal disease patients on peritoneal dialysis?

Jonas Axelsson¹ ;Jonas Axelsson¹ ;Jonas Axelsson¹ ;Jonas Axelsson¹ ;Jonas Axelsson¹ ;Jonas Axelsson¹

Karolinska Institute

E-mail address corresponding author:
jonas.axelsson@klinvet.ki.se

Background:
Malnutrition is common in end-stage renal disease (ESRD) and affects both morbidity and mortality, but there is currently no precise and simple nutritional marker in widespread use. In the present study, we investigate the possible value of IGF-I and IGFBP-1 and -3 as such a marker in PD patients.

Methods:
Cross-sectional analysis at start of therapy of 159 PD patients (92 males; 58%) with a mean age of 53±1 years and a mean RRF of 7±1 mL/min. Biochemical analyses of insulin, IGF-I, IGFBP-1, IGFBP-3, IL-6, hs-CRP and other routine markers. Malnutrition status was recorded using subjective global assessment (SGA), body mass index, estimated protein intake from nitrogen appearance (nPNA), handgrip strength (HGS) and insulin resistance (HOMA-IR).

Results:
Both IGF-I and IGFBP-1 showed significant and opposite correlations with most markers of nutritional status, including SGA (rho -0.27 and 0.41; p<0.001), nPNA (rho 0.18 and -0.22; p<0.05), S-creatinine (rho 0.09 and -0.26; p<0.01), and HGS (rho 0.21 and -0.36; p<0.05). IFG-I was strongly correlated with IGFBP-3 (rho 0.54; p<0.001) and inversely correlated with IGFBP-1 (rho -0.41; p<0.001). Both IGF-I and IGFBP-3, but not IGFBP-1, were significantly correlated with age (rho -0.24 for IGF-I and -0.33 for IGFBP-3; p<0.001) and IGF-BP3 also correlated with hsCRP (rho -0.23; p<0.05). In multivariate analyses, IGFBP-1, but not IGF-I or IGFBP-3, were predictors of SGA (model r2=0.29; p<0.001), HGS (model r2=0.40; p<0.001) and s-albumin (model r2=0.17; p<0.001) independently of age, gender, inflammation, triglycerides, and diabetes.

Conclusion:
Both IGF-I and, especially, IGFBP-1 correlate well with several aspects of protein-energy malnutrition and sarcopenia in PD patients suggesting that they should have a more prominent role in clinical practice. IGFBP-3 does not correlate with nutritional status in ESRD, perhaps because of a strong association with inflammation.

Subject:
Peritoneal Dialysis

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