Nephrology Dialysis Transplantation, Vol 14, Issue 3 723-727, Copyright © 1999 by Oxford University Press
O Heimbuger, T Wang, F Lonnqvist and P Stenvinkel
Introduction. The ob gene product
leptin is secreted by fat cells and the serum leptin levels reflects the
body fat content. Markedly elevated serum leptin levels have been reported
in patients with chronic renal failure. The aim of the present study was to
assess if the dialysate leptin levels in peritoneal dialysate are similar
to what can be expected from passive diffusion or if intraperitoneal
synthesis of leptin may occur. Methods. We studied 39
patients (20 males), mean age 54±12 years, who had been treated
with peritoneal dialysis for 17±12 months. Ten of the patients
were diabetics of which seven used intraperitoneal insulin. A 24-h
collection of dialysate was performed and dialysate and fasting blood
samples were analysed for leptin, albumin and {beta}2-microglobulin, and
the peritoneal clearances (PCI) were calculated for these solutes.
Results. Serum leptin (mean 47±76, range
3-350 ng/ml) was related to body mass index (r=0.35,
P<0.05). In multiple regression analysis, serum
leptin also correlated to serum TNF-&agr;. Although dialysate leptin
levels correlated to serum leptin, they were higher than expected from the
molecular weight of 16 kD. PCl of leptin was 1.3 ml/min (range 0.2-5.9
ml/min), which was 1.6 times higher than expected from the molecular weight
of leptin and PCl for albumin and {beta}2-microglobulin, not taking the
protein binding of leptin into account. A strong correlation was found
between PCl for albumin and &bgr'2-microglobulin
(r=0.68, P<0.0001) but
neither PCl albumin, nor PCl {beta}2-microglobulin correlated to PCl
leptin. The PCl of leptin was markedly higher in diabetics using
intraperitoneal insulin (n=7) compared to the other 32
patients (2.6±2.0 vs 1.1±0.7
ml/min, P<0.05). Conclusion.
Serum leptin is locally produced in the peritoneal cavity, and
intraperitoneal insulin enhances local production of leptin.
Keywords: leptin; peritoneal dialysis; insulin;
TNF-&agr;
ORIGINAL ARTICLES
Peritoneal clearance of leptin in CAPD patients: impact of local insulin administration
Department of Clinical Science and Department of Medicine, Division s of Renal Medicine and Baxter Novum, K56, Karolinska Institute, Huddinge University Hospital, S-141 86 Huddinge, Sweden; Corresponding author
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