Nephrology Dialysis Transplantation, Vol 14, Issue 2 400-405, Copyright © 1999 by Oxford University Press
A Kagan, N Haran, L Leschinsky, N Shuali and J Rapoport
Background: To determine whether serum leptin
concentrations in patients undergoing continuous ambulatory peritoneal
dialysis (CAPD) are influenced by peritoneal loss of leptin and to compare
serum leptin levels of normal subjects with those of patients receiving
renal replacement therapy such as haemodialysis (HD), CAPD, or kidney
transplantation. Subjects and methods. Eighty-four
individuals were investigated: six females and 14 males on standard CAPD;
13 females and 13 males on chronic HD; 10 female and eight male kidney
transplant recipients and 10 female and 10 male subjects as controls.
Morning serum, 8-h and 24-h samples of peritoneal fluid concentrated to
6-20-fold by Centricon 3 (cutoff 3000 daltons), and 24-h urinary
concentrations of leptin were measured with commercial RIA (Linco Research,
Inc., USA). Venous blood and peritoneal fluid samples of albumin,
{beta}2-microglobulin, glucose, urea, and creatinine were determined by
standard laboratory techniques. Serum insulin levels were measured by
radioimmunoassay. Results: Patients (men and women) on
CAPD and after kidney transplantation exhibited significantly higher serum
concentrations of leptin and leptin/BMI ratios than control subjects. These
increased values did not reach statistical significance in HD patients.
Serum leptin concentrations were correlated very significantly with BMI in
all cases (r=0.380, P<0.001). Moreover, in CAPD patients (r=0.630,
P<0.007) and in HD patients (r=0.668, P<0.005), but not in
kidney transplant recipients or control subjects, significant correlations
were observed between serum leptin and insulin concentrations. Residual
renal function (RRF) in the range 0-12.8 ml/min and serum
{beta}2-microglobulin levels in the range 7.8-47.1 mg/l did not
influence serum leptin levels in CAPD and HD patients. As expected, leptin
was detected in the peritoneal fluid of CAPD patients. Twenty-four-hour
peritoneal loss (30.95±21.05 ng/min) and 24-h peritoneal
clearance (0.01±0.01 ml/kg/min) of leptin account for only 3.9%
of estimated whole-body leptin production rate and 0.7% of leptin clearance
from plasma respectively. Twenty-four-hour urinary losses of leptin in CAPD
patients were negligible, accounting for 5.6±1.8% (range
0.3-15.2%) of total (peritoneal and urinary) loss of this hormone.
Conclusions: These findings suggest that serum leptin
levels are not affected by continuous peritoneal loss of leptin during CAPD
and that insulin resistance and hyperinsulinaemia contribute to elevated
serum leptin concentrations in CAPD and HD patients. The aetiology of
increased serum leptin levels in kidney transplant recipients is probably
different from that in dialysis patients. Key words:
{beta}-microglobulin; body mass index; haemodialysis; insulin; kidney
transplantation; leptin; peritoneal dialysis; peritoneal loss; residual
renal function
ORIGINAL ARTICLES
Leptin in CAPD patients: serum concentrations and peritoneal loss
Department of Nephrology and Hypertension, Kaplan Hospital, PO Box 1, Rehovot 76100, Israel; Corresponding author
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