Nephrology Dialysis Transplantation, Vol 12, Issue 7 1321-1325, Copyright © 1997 by Oxford University Press
P Stenvinkel, O Heimburger and F Lonnqvist
BACKGROUND: The ob gene product leptin is secreted by fat cells and
reflects the content of fat in the body. Leptin and insulin concentrations
as well as body weight are interrelated and a direct correlation has been
found between these concentrations in humans with normal renal function.
Markedly elevated serum leptin concentrations have recently been reported
in patients with chronic renal failure (CRF). The aim of the present study
was to investigate the relation between serum leptin and plasma insulin in
patients with advanced CRF. METHODS: Serum leptin, plasma insulin, as well
as body fat content (determined with dual-energy X-ray absorptiometry) were
determined in a cohort of 46 patients (mean age 54 +/- 2 years) with
advanced CRF (creatinine clearance 8 +/- 1 ml/min). RESULTS: In 23 CRF
patients with plasma insulin below the median value (14 mU/l), serum leptin
concentrations were no higher than in healthy controls (8.0 +/- 1.2 vs 8.4
+/- 0.9 ng/ml). However, in CRF patients with plasma insulin > 14 mU/l
(n = 23) the serum leptin concentrations were much higher (38.2 +/- 11.0
ng/ml; P < 0.0001). In CRF patients, serum leptin (normalized for the
per cent body fat content) correlated significantly (r = 0.64; P <
0.0001) with plasma insulin concentrations. However, the increase in plasma
insulin was blunted in patients with very high serum leptin concentrations
in relation to the per cent body fat content. CONCLUSIONS: The present
results demonstrate that serum leptin concentrations are markedly elevated
in CRF patients with higher plasma insulin than in those with lower plasma
insulin concentrations. This suggests that insulin resistance and
hyperinsulinaemia contribute to elevated serum leptin concentrations in
CRF. The present results also demonstrate that, when circulating serum
leptin concentrations are much higher in relation to the per cent body fat
content, no additional increase in plasma insulin occurs. This latter
observation suggests that the secretion of insulin by the pancreas is lower
in hyperleptinaemic patients. Consequently, extremely elevated serum leptin
may play a role in reducing glucose-stimulated insulin secretion and
glucose intolerance in CRF.
ORIGINAL ARTICLES
Serum leptin concentrations correlate to plasma insulin concentrations independent of body fat content in chronic renal failure
Department of Clinical Science, Karolinska Institute, Huddinge University Hospital, Stockholm, Sweden.
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