Association with Helicobacter pylori infection and ghrelin level in hemodialysis patients

To the Editor: We read with interest the article by Carrero et al. 1 entitled ‘Protein-energy wasting modifies the association of ghrelin with inflammation, leptin, and mortality in hemodialysis patients’. In this study, low ghrelin levels in protein-energy wasted hemodialysis patients are linked to a markedly increased cardiovascular mortality risk and reveals the possibility that ghrelin therapies may be useful for hemodialysis patients with low ghrelin levels. 1 Ghrelin is an orexigenic peptide released primarily from gastric endocrine cells, which increases appetite and adjusts energy balance as biological roles. 2 Recently, one of the major factors influenced in serum ghrelin levels was reported to be Helicobacter pylori infection in gastric mucosa. H. pylori infection decreases ghrelin production from gastric endocrine cells, leading to lower plasma and gastric mucosal ghrelin levels. Moreover, expression of gastric ghrelin mRNA significantly increases after either peptic ulcer healing or H. pylori eradication. 3 Changes in plasma ghrelin levels before and after H. pylori eradication are inversely correlated with body weight change. Although we previously reported that Japanese hemodialysis patients had significant lower prevalence of H. pylori (48.6%, 262/539) compared with patients with normal renal function (78.5%, 314/400), 4 influences of H. pylori infection in hemodialysis patients cannot be ignored. It remains possible that H. pylori infection influences this recent result. 1 Therefore, the conclusion may be misleading by lack of the data of H. pylori status, and this study may suggest that H. pylori infection in hemodialysis patients is a risk factor for development of cardiovascular diseases.