Supplementary Material for: Severity of Gastric Mucosal Atrophy Is the Major Determinant of Plasma Ghrelin Level in Hemodialysis Patients

<i>Background:</i> Ghrelin, an orexigenic hormone, has multiple favorable functions including protein anabolism enhancement, anti-inflammatory actions, and cardiovascular protection. A low plasma ghrelin level is associated with increased mortality in patients treated with hemodialysis (HD). However, it is unclear whether the plasma ghrelin level in HD patients correlates with the severity of gastric mucosal atrophy and <i>Helicobacter pylori</i> status. <i>Methods:</i> Seventy-eight maintenance HD patients and 51 non-dialysis patients with chronic kidney disease were evaluated for severity of gastric mucosal atrophy by gastroduodenoscopy and for <i>H. pylori</i> status using an anti-<i>H. pylori</i>-antibody and rapid urease test. Plasma acyl and des-acyl ghrelin levels were measured and their associations with relevant clinical parameters were investigated. <i>Results:</i> Des-acyl ghrelin level in HD patients was significantly higher than that in patients with kidney function preserved. Although acyl and des-acyl ghrelin levels were similar between current <i>H. pylori </i>positive and negative HD patients, both levels decreased significantly with the progress of endoscopic gastric mucosal atrophy in HD patients. Serum pepsinogen (PG) I level and PG I/II ratio decreased significantly according to the severity of atrophy in HD patients and positively significantly correlated with both ghrelin levels. Multiple regression analysis showed significant positive correlations between acyl ghrelin and PG I levels (β = 0.738, p &lt; 0.001) and significant negative correlations between ghrelin and age, albumin, and creatinine levels. <i>Conclusions:</i> Gastric atrophy is the major determinant of ghrelin level in HD patients. Management practices, such as <i>H. pylori</i> eradication, before advanced atrophy may be required to prevent the decrease of ghrelin levels and improve the prognosis of HD patients.

<i>背景：</i> 饥饿素（ghrelin）是一种促食欲激素，具备多项有益生理功能，包括增强蛋白质合成代谢、发挥抗炎作用以及提供心血管保护。血液透析（HD）患者若血浆饥饿素水平偏低，其死亡风险会升高。然而目前尚不明确，血液透析患者的血浆饥饿素水平是否与胃黏膜萎缩程度及幽门螺杆菌（Helicobacter pylori）感染状态存在关联。
<i>方法：</i> 本研究纳入78例维持性血液透析患者与51例未接受透析的慢性肾脏病患者，通过胃十二指肠镜检查评估胃黏膜萎缩程度，并采用抗幽门螺杆菌抗体检测与快速尿素酶试验判定幽门螺杆菌感染状态。同时检测血浆酰化饥饿素（acyl ghrelin）与去酰化饥饿素（des-acyl ghrelin）水平，探究其与相关临床参数的关联。
<i>结果：</i> 血液透析患者的去酰化饥饿素水平显著高于肾功能保留的患者。尽管当前幽门螺杆菌阳性与阴性的血液透析患者之间，酰化饥饿素与去酰化饥饿素水平并无显著差异，但随着内镜下胃黏膜萎缩程度加重，这两种饥饿素水平均出现显著下降。在血液透析患者中，血清胃蛋白酶原（PG）I水平及PG I/II比值随萎缩程度加重而显著降低，且与两种饥饿素水平均呈显著正相关。多元回归分析结果显示，酰化饥饿素与PG I水平呈显著正相关（偏回归系数β=0.738，p<0.001），而饥饿素水平与年龄、白蛋白及肌酐水平呈显著负相关。
<i>结论：</i> 胃黏膜萎缩是影响血液透析患者饥饿素水平的主要决定因素。为防止饥饿素水平下降并改善血液透析患者的预后，可能需要在胃黏膜萎缩进展至晚期前，采取幽门螺杆菌根除治疗等干预措施。