Serum C-reactive protein and leptin for assessment of nutritional status in patients on maintenance hemodialysis

Abstract

Nutrition is one of the key parameters in predicting morbidity and mortality in patients with end-stage renal disease (ESRD) on hemodialysis. Body weight, body mass index, and visceral protein levels (serum protein, albumin, prealbumin, and transferrin) have traditionally been used as markers for nutritional status. Serum leptin and C-reactive protein (CRP), have been recently added to the list of markers for nutritional status. This study was a comparative assessment of serum leptin and CRP for nutritional status in patients with ESRD on maintenance hemodialysis. A total of 40 patients with ESRD on maintenance hemodialysis and a similar number of age-, gender-, and BMI-matched healthy individuals were studies. Complete medical history was obtained and relevant clinical examination including anthropometry was carried out. All the individuals were subjected to routine investigations and special investigations (serum leptin and CRP). Data were analyzed using Student's t-test and correlation was found using Pearson's correlation coefficient. Mean value of serum leptin for the study group (1.44 ± 0.72 ng/ml) was found to be significantly higher than that of the control group (0.68 ± 0.55 ng/ml). In addition, we also observed a positive correlation between serum leptin and BMI (r = 0.350, P<0.05). For CRP, we observed that the study group (3.93 ± 1.20 mg/ml) had a significantly higher value vis-à-vis the control group (0.28 ± 0.24 mg/ml). However, CRP and BMI did not show a significant correlation. Based on the above observations, we conclude that serum leptin is a better biomarker than CRP for assessing nutritional status in patients with ESRD on maintenance hemodialysis.

Leptin Level Relationship With Nutritional, Inflammatory and Cardiovascular Risk Factors in Non-Diabetic Esrd Iraqi Patients

“…The results of the present study have shown significantly higher serum leptin levels in patients with advanced CKD, particularly in those undergoing dialysis in comparing with the control group (p <0.01).There is a close agreement with results reported by two previous studies 17,18 . There was a significant negative correlation between leptin level and e GFR as shown in figure 1and positively correlated with creatinine (r=0.38 ,p<0.010) and cystatin c, (r= 0.31 p<0.05) which are the most important markers for the assessment of renal function in CKD patients 19 .…”

“…There is a significant agreement of these results with other studies which observed that ESRD patients with high leptin levels had more inflammatory activation ,which is represented by high levels of serum hsCRF [24][25][26] , this may increase the rate of mortality in ESRD patients who are on maintenance haemodialysis due to cardiovascular disease (CVD) based on the critical role of hsCRP in endothelial injury, and pathogenesis of atherosclerosis 27 . hsCRP is an important inflammatory marker that plays a role in cytokine release, was associated with increased rate of mortality in ESRD patients 17,28,29 . Bonanni et al in their study had concluded that the increase in inflammatory marker levels in HD patients, may be related to the exposure of blood to bio incompatible dialysis membranes 30. Other important risk factors that play role in CVD in hemodialyized patients is the obesity which leads to dyslipidemia.…”

How should procalcitonin and C‐reactive protein levels be interpreted in haemodialysis patients?

“…[8][9][10][11][12] The high level of PCT, on the other hand, has been linked to the effect of cytokines released due to the microvascular interaction during HD. These studies have reported that both of these parameters are higher than those in the normal population.…”

“…These studies have reported that both of these parameters are higher than those in the normal population. 2,[5][6][7][8][9][10][11][12][13][14][15][16] Studies have linked the high level of CRP to the fact that when leukocytes face the dialysis membranes, the cytokines released from inflammatory cells trigger the inflammatory process. [8][9][10][11][12] The high level of PCT, on the other hand, has been linked to the effect of cytokines released due to the microvascular interaction during HD.…”

“…2,[5][6][7][8][9][10][11][12][13][14][15][16] Studies have linked the high level of CRP to the fact that when leukocytes face the dialysis membranes, the cytokines released from inflammatory cells trigger the inflammatory process. [8][9][10][11][12] The high level of PCT, on the other hand, has been linked to the effect of cytokines released due to the microvascular interaction during HD. [13][14][15][16][17][18] Looking at the studies in which these two parameters were assessed in combination, Level et al 19 studied the PCT and CRP levels of 62 HD patients: 30 males and 32 females with a mean age of 61.8 AE 17.1.…”