Association of Serum Adipokines and Resting Energy Expenditure in Patients With Chronic Kidney Disease

Abstract

Background and AimMetabolic disorders are prevalent in patients with chronic kidney disease (CKD) and may lead to protein energy wasting (PEW). Adipokines improve connections between PEW and energy metabolism. We aimed to determine the relationship between adipokine levels and resting energy expenditure (REE) in patients with CKD.MethodsA total of 208 patients in non-dialyzed CKD stages 3–5 were enrolled in this cross-sectional study. Serum adipokines (leptin, adiponectin, and interleukin 6 (IL-6) were measured using enzyme-linked immunosorbent assay. Patient's REE was measured using indirect calorimetry. Fat mass (FM) and lean tissue mass (LTM) were measured using multiple-frequency bioimpedance analysis. Spearman correlation analyses and multivariate linear regression models were used to assess the association between serum adipokines and REE.ResultsThe mean age was 52.7 ± 14.6 years, and 26.9, 26.4, and 46.7% of our participants had CKD stages 3, 4, and 5, respectively. The median values of serum adiponectin, leptin, and IL-6 were 470.4 (range, 291.1–802.2), 238.1 (range, 187.9–418.4), and 4.0 (range, 2.4–9.5) pg/mL, respectively. The male participants had significantly lower FM% (P = 0.001) and lower leptin levels (P < 0.001) than the female participants. After adjusting for age, diabetes, high-sensitivity C-reactive protein, intact parathyroid hormone, LTM, and FM, multiple linear regression analysis revealed that serum leptin levels were significantly positively associated with REE in men rather than in women (P < 0.05). Serum adiponectin levels were inversely associated with REE in men, but this association disappeared while FM was additionally adjusted. Adiponectin levels in women were not correlated with REE (P > 0.05). IL-6 was not significantly associated with REE in either men or women.ConclusionsA sex-specific relationship between serum adipokines (leptin and adiponectin) and REE was observed in patients with CKD stages 3–5, which was partly confounded by FM.

Malnutrition and Erythropoietin Resistance among Patients with End-Stage Kidney Disease: Where Is the Perpetrator of Disaster?

“…These data suggest that high leptin levels are generally seen in individuals who are well-nourished and score low on MIS scale. Women tend to have higher leptin levels, which is consistent with available data and is thought to be caused by leptin-estrogen interplay [35,36]. Leptin is an interesting adipokine with a multitude of biological actions.…”

“…In a small study by Rafieian-Kopaei, higher leptin levels were associated with higher hemoglobin and lower EPO requirements in ESRD [39]. Abi et al studied the association between leptin levels and resting energy expenditure (REE) in a CKD stage 3-5 KDIGO population without hemodialysis and found a positive correlation of leptin and REE independently of sex-energy expenditure was greater with higher leptin levels [36]. Authors of the aforementioned study hypothesized that leptin antagonist or LepR-blocker administration in this population may help ameliorate PEW and cachexia in the course of CKD, just as it did in animal studies [42,43].…”