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Associations between insulin-like growth factor-1 standard deviation score and overall nutritional parameters in patients with maintenance hemodialysis: a cross-sectional study

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Abstract

Background

This study investigated the association between insulin-like growth factor-1 and nutritional status indicators in patients undergoing maintenance hemodialysis (MHD).

Methods

Patients undergoing MHD for > 3 months were included in this single-center cross-sectional study in March 2021. Clinical, demographic, and body mass data and blood samples were collected before the hemodialysis sessions. Serum insulin-like growth factor-1 (IGF-1) levels were measured using a radioimmunoassay, and serum IGF-1 standard deviation score (SDS) was calculated for MHD patients according to age and sex. The nutritional status of patients was assessed using serum albumin, serum prealbumin, handgrip strength, pinching strength, upper arm muscle circumference, lean body mass, phase angle, seven-point subjective global assessment (SGA) score, and geriatric nutritional risk index (GNRI). The patients were divided into groups according to tertiles of serum IGF-1 SDS levels. Spearman correlation analyses and univariate and multivariate binary logistic regression analyses were used to determine the association between serum IGF-1 SDS and nutritional status parameters.

Results

A total of 155 MHD patients (male: female = 90:65) were enrolled in the study, with a median dialysis vintage of 28.0 (11.0, 55.0) months, and an average age of 66 (65.5 ± 13.0) years. The median of IGF-1 SDS was − 0.1 (− 0.6 to 0.6). Compared to patients with higher IGF-1 SDSs, patients with lower IGF-1 SDSs had lower levels of serum ceruloplasmin (341.0 [287.5, 416.0] vs 395.0 [327.0, 451.0] vs 409.0 [349.5, 507.5], p = 0.002), serum albumin (34.7 ± 3.0 vs 37.0 ± 3.1 vs 37.8 ± 2.6, p < 0.001), serum prealbumin (270.3 [233.7, 327.8] vs 326.0 [279.3, 355.6] vs 363.0 [324.2, 398.2], p < 0.001), handgrip strength (13.8 [10.0, 20.7] vs 17.7 [10.7, 22.5] vs 23.3 [16.6, 27.8], p < 0.001), pinch strength (4.6 [3.9, 6.0] vs 4.9 (3.9, 6.9) vs 6.5 [4.7, 8.7], p = 0.002), phase angle (3.3 [3.0, 3.8] vs 3.9 [3.4, 4.7] vs 4.3 [3.6, 5.2, p < 0.001), modified Creatinine Index (83.1 ± 19.7 vs 93.1 ± 23.4 vs 113.9 ± 24.3, p < 0.001), intracellular water (14.5 ± 4.4 vs 16.1 ± 4.9 vs 16.9 ± 4.4, p = 0.031), higher extracellular water (26.9 ± 5.8 vs 25.7 ± 5.5 vs 25.1 ± 3.1, p = 0.042), and higher malnutrition risk as defined by GNRI (49.0% vs 15.7% vs 11.5%, p < 0.001) and SGA (53.9% vs 23.5% vs 7.7%, p < 0.001).

Conclusions

Lower IGF-1 SDSs are independently associated with higher malnutrition risk in patients with MHD.

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Data availability statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Abbreviations

MHD:

Maintenance hemodialysis

CKD:

Chronic kidney disease

ESRD:

End-stage renal disease

SGA:

Seven-point subjective global assessment

GNRI:

Geriatric Nutritional Risk index

GH:

Growth hormone

IGFBPs:

Insulin-like growth factor bind proteins

IGF-1:

Insulin-like growth factor-1

IGF-1 SDS:

Insulin-like growth factor-1 standard deviation score

PEW:

Protein-energy wasting

DM:

Diabetes mellitus

IL-6:

Interleukin-6

hs-CRP:

Hypersensitive C-reactive protein

mCI:

Modified Creatinine Index

ECW:

Extracellular body water

ICW:

Intracellular body water

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Acknowledgements

The authors are indebted to all nephrologists and nurses in the nephrology department of Guangzhou Red Cross Hospital, Jinan University for their excellent management of hemodialysis patients. We thank the patients and staff involved in this cross-sectional study. We especially thank Shilin Xu, B.S. Nurs, because all the laboratory data in the study were derived from the electronic management system for blood purification center (Hope®, software) developed by him, which can import the laboratory test results according to the patients’ IDs included in the study.

Funding

This work was supported by the Science and Technology Program of Guangdong Province (Grant No. 2017B090904027), the Research Program of Sports Bureau of Guangdong Province (Grant No. GDSS2020M003), the Foundation for Young Talents of Chinese Nutrition Society (Chinese Nutrition Society Office (2020) No. 51), the Research-oriented Hospital Program of Guangzhou (Grant No. 2022RHPG05), And the Guangzhou Clinically Characteristic Technology Project (Grant No. 2019TS60).

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Author notes

  1. Tingting Xing and Yao Xu have contributed equally to this work.

Authors and Affiliations

  1. Clinical Collage of Medicine, Guizhou Medical University, Guiyang, Guizhou, People’s Republic of China

    Tingting Xing & Rongshao Tan

  2. Department of Nephrology, The 2nd People’s Hospital of Bijie, Bijie, Guizhou, People’s Republic of China

    Yao Xu & Yun Liu

  3. Department of Nephrology, South China Hospital of Shenzhen University, Shenzhen, Guangdong, People’s Republic of China

    Jiaqi Li

  4. Guangzhou Institute of Disease-Oriented Nutritional Research of Guangzhou Red Cross Hospital, Jinan University, Guangzhou, Guangdong, People’s Republic of China

    Luona Wen, Rongshao Tan & Yan Liu

  5. Department of Nephrology, Jiangmen Central Hospital, Jiangmen City, Guangdong, People’s Republic of China

    Qingdong Xu

  6. Department of Nephrology, Guangzhou Red Cross Hospital of Jinan University, Guangzhou, Guangdong, People’s Republic of China

    Weifeng Liang, Pan Liang, Yun Liu, Yan Liu & Xiaoshi Zhong

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Contributions

TX contributed to the study design, partial data collection, and drafting of the manuscript. Yao Xu was involved in the analysis and interpretation of the data. JL, LW, QX, WL, and PL collected data. YL, RT, YL, and XZ were involved in the study design and critical revision of the manuscript for important intellectual content. All authors read and approved the final manuscript.

Corresponding authors

Correspondence to Yun Liu or Rongshao Tan.

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Conflict of interest

The authors have declared that no conflict of interest exists.

Ethical approval

This study was approved by the Ethics Committee of Guangzhou Red Cross Hospital [No. 2021-066-01]. This study adhered to the tenets of the Declaration of Helsinki and the Guidance on Sample Collection of Human Genetic Diseases by the Ministry of Public Health of China and does not contain any studies with animals performed by any of the authors.

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Informed consent was obtained from all individual participants included in the study.

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Xing, T., Xu, Y., Li, J. et al. Associations between insulin-like growth factor-1 standard deviation score and overall nutritional parameters in patients with maintenance hemodialysis: a cross-sectional study. Int Urol Nephrol 55, 2257–2266 (2023). https://doi.org/10.1007/s11255-023-03526-z

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