Maintenance hemodialysis (HD) patients often experience fluctuations of volume status. Although hypervolemia possibly induces systemic inflammation, the relationship between volume status and leptin has not yet been well defined. The aims of this study were to determine the levels of leptin, C-reactive protein (CRP), and ferritin in relation to volume status and to assess the relationship between leptin and volume and inflammatory status in chronic HD patients. This prospective study included 93 HD patients divided, based on evaluation using the body composition monitor, into normovolemic and hypervolemic groups (overhydration/extracellular water [OH/ECW] ≤ 15% and OH/ECW > 15%, respectively). The levels of leptin and inflammatory markers (CRP, ferritin) were determined during a mid-week dialysis session in all patients. There were more hypervolemic patients after 12 months of follow up than at baseline (41% vs. 38%). Hypervolemic patients had significantly lower leptin levels (11.42 ± 19.24 ng/mL vs. 34.53 ± 40.32 ng/mL at baseline and 13.41 ± 22.04 ng/mL vs. 41.54 ± 21.78 ng/mL at 12 months), longer time on dialysis, and poorer nutritional status than normovolemic patients. Inflammation was present regardless of the volume status, but hypervolemic patients had significantly higher CRP and ferritin than normovolemic patients. A statistically significant reverse correlation was found between leptin level, hyperhydration index, and OH/ECW. No significant correlation was found between leptin and inflammatory markers CRP and ferritin.

Introduction. Hemodialysis (HD) patients have higher mortality rate than the general population. Recent studies indicate a significant role of non-cardiovascular risk factors in for mortality in HD patients. Leptin is protein hormone and may indicate malnutrition in HD patients. Its role in mortality in these patients is being examined. This study aimed to investigate the correlation between serum leptin levels and non-cardiovascular risk factors and relationship between leptin level and mortality in HD patients. Methods The prospective study included 93 patients on maintenance HD and follow-up period was 12 months. We measured leptin level and evaluated non-cardiovascular risk factors: nutritional status, anemia, volemia, parameters of mineral and bone disorder. Results. Out of 93 patients 9 died during study and 1 underwent kidney transplantation. Malnutrition and hypervolemia were two main non-cardiovascular risk factors among deceased subjects. Leptin showed a significant direct correlation with nutritional BMI (r = 0.72, P <0.001), fat tissue index (r = 0.74, P <0.001) and statistically significant inverse correlation with leantissue index (r = -0.349, P <0.05) and inverse correlation with volemic parameters (overhydration / extracellular water ratio (r = -0.38, P <0.001), but no association with anemia and mineral bone parameters was observed. Elevated leptin levels were associated with better survival. However, no statistically significant difference in survival rates was observed between the study groups (Log-Rank P =0.214, Breslow P =0.211, Tarone-Ware P=0.212). Conclusion: Deceased patients had significantly lower leptin values. Leptin was associated with two non-cardiovascular risk factors for mortality: malnutrition and hypervolemia.

Background Two types of fixed-ratio combinations of basal insulin and a glucagon-like peptide-1 receptor agonist (GLP-1RA) have been approved for use in type 2 diabetes. One is insulin degludec/liraglutide (iDergLira), and the other is insulin glargine/lixisenatide (iGlarLixi). Direct comparisons between these two combination is not available. Methods The retrospective study included 186 patients with type 2 diabetes mellitus (DM) with inadequate glycemic control on metformin and basal insulin (degludec, glargine 100, glargine 300) who were switched to fixed-ratio combination GLP-1 RA and basal insulin. Patients were divided into two groups based on the basal insulin before study: group I (n = 86) treated with degludec were switched to iDegLira and patients group II (n = 99), treated with glargine were switched to iGlarLixi. The aim of this study was to directly compare the effects between two fixed – ratio combination on glycemic parameters and non glycemic parameters. Follow up was 6 months. Results Mean HbA1c decreased similarly (− 1.2% vs.-1.1%). Higher percentage patients in iDegLira group had reached the HbA1c < 7% after 6 months (22% vs. 18.2%, p < 0.05). The mean change in fasting plasma glucose (FPG) was comparable for the two groups, while mean decrease postprandial plasma glucose (PPG) level were lower in iGlarLixi group (2 vs 1.8 mmol/l, p > 0.05). Change in body weight was significant in iDegLira group (1.8 kg vs. 0.7 kg, p < 0.001). At the end of the study patients showed decrease in total cholesterol (TC) and low-density lipoprotein (LDL) for 0.2 mmol/L in iDegLira, 0.1 mmol/l in iGlarLixi, triglycerides decreased 0.3 mmol/l in both groups, high-density lipoprotein(HDL) increased 0.1 mm/l in iGlarLixi. Conclusion Our results showed that more patients with iDegLira had HbA1c less than 7% and these combination had better effect on weight loss. There was no difference observed in FPG and PPG, lipid profile and rate of hypoglycemia.

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