Interrelationship between plasma leptin concentration and severity of metabolic acidosis in haemodialysed patients with chronical renal failure

Summary:

Patients with chronic renal failure are frequently characterized by malnutrition, hyperleptinaemia and metabolic acidosis. Both hyperleptinaemia and chronic metabolic acidosis are presumed to contribute to the pathogenesis of malnutrition observed in this group of patients. It has been reported, that in vitro adipocytes exposed to acidotic medium decrease leptin secretion. The aim of present study was to analyze the possible impact of uraemic metabolic acidosis on leptinaemia in haemodialysis patients with chronic renal failure. - 94 haemodialysed patients (58 M, 36 F; mean age 45 ± 1 years) were enrolled in this study. 56 patients were on haemodialysis treatment for one year using an acetate dialysis fluid, while 38 patients were haemodialysed at least for 3 months with a dialysate buffered with bicarbonate. Plasma leptin concentration, blood gases and body composition were assessed in all examined subjects. - Patients haemodialysed with an acetate and bicarbonate buffered dialysate did not differ with respect to body weight, body mass index (BMI), total fat mass (TFM) and plasma leptin concentration. Patients haemodialysed with an acetate buffered dialysate were characterized by a significantly more severe metabolic acidosis than patients on bicarbonate haemodialysis. Patients were divided according to the actual hydrogen ion concentration: over 60 nmol/l, 45-60 nmol/l and below 45 nmol/l. These subgroups did not differ significantly by body weight, BMI and TFM. Only a slightly (not significantly), lower median leptinaemia was found in patients with elevated hydrogen ion concentration. No significant correlation was noticed between blood hydrogen or hydrocarbonate ion concentration respectively and logarithmic values of plasma leptin concentration (τ = 0.025, p = 0.72; τ = - 0.021, p = 0.76 respectively). - From results obtained in this study we may conclude that, blood hydrogen ion concentration does not influence substantially or only moderately to plasma leptin concentration in haemodialysed patients.

Leptin - uraemia - haemodialysis - acidosis

References

• 1 Barr V A, Malide D, Zarnowski M J, Taylor S I, Cushman S W. Insulin stimulates both leptin secretion and production in white adipose tissue.  Endocrinology. 138 4463-4472 1997; 
• 2 Boden G, Chen X, Kolaczynski J W, Polansky M. Effect of prolonged hyperinsulinemia on serum leptin in normal human subjects.  J Clin Invest. 100 1107-1113 1997; 
• 3 Cumin F, Baum H P, Levens N. Mechanism of leptin removal from the circulation by the kidney.  J Endocrinol. 155 577-585 1997; 
• 4 Dagogo-Jack S, Fanelli C, Paramore D, Brothers J, Landt M. Plasma leptin and insulin relationships in obese and nonobese humans.  Diabetes. 45 695-698 1996; 
• 5 Dasher M, Tönshoff B, Blum W F, Englaro P, Wingen A M, Schaefer F, Wuhl E, Rascher W, Mehls O. Inappropriate elevation of serum leptin levels in children with chronic renal failure.  J Am Soc Nephrol. 9 1074-1079 1998; 
• 6 Fluck C E, Kuhlmann B V, Mullic P E. Insulin increases serum leptin concentration in children and adolescents with newly diagnosed type I diabetes mellitus with and without ketoacidosis.  Diabetologia. 42 1067-1070 1999; 
• 7 Garibotto G, Russo R, Sofia A, Rita Sala M, Sabatino C, Moscatelli P, Deferrari G, Tizzinello A. Muscle protein turnover in chronic renal failure patients with metabolic acidosis or normal acid-base balance.  Miner Electrolyte Metab. 22 58-61 1996; 
• 8 Hathout E H, Sharke J, Racine M, Ahn D, Mace J W, Saad M F. Changes in plasma leptin during the treatment of diabetic ketoacidosis.  J Clin Endocrinol Metab. 84 4545-4548 1999; 
• 9 Heimbürger O, Lönnqvist F, Danielsson A, Nordenström J, Steinvinkel P. Serum immunoreactive leptin concentration and its relation to the body fat content in chronic renal failure.  J Am Soc Nephrol. 8 1423-1430 1997; 
• 10 Hjemdahl P, Fredholm B B. Direct antilipolytic effect of acidosis in isolated rat adipocyte.  Acta Physiol Scand. 101 294-301 1977; 
• 11 Johansen K L, Mulligan K, Tai V, Schambelan M. Leptin, body composition, and indices of malnutrition in patients on dialysis.  J Am Soc Nephrol. 9 1080-1084 1998; 
• 12 Kokot F, Chudek J, Karkoszka H, Adamczak M, Wieçek A, Klimek D. Does PTH influence leptin concentration in haemodialysed uraemic patients?.  Nephron. 82 372-373 1999; 
• 13 Kolaczynski J W, Considine R V, Ohanessian J, Marco C, Opentanova I, Nyce M R, Myint M, Caro J F. Responses of leptin to short-term fasting and refeeding in humans. a link with ketogenesis but not ketones themselves.  Diabetes. 45 1511-1515 1996; 
• 14 Kolaczynski J W, Nyce M R, Considine R V, Boden G, Nolan J J, Henry R, Mudaliar S R, Olefsky J, Caro J F. Acute and chronic effect of insulin on leptin production in humans. Studies in vivo and in vitro.  Diabetes. 45 699-701 1996; 
• 15 Marckmann P. Nutritional status of patients on haemodialysis and peritoneal dialysis.  Clin Nephrol. 29 75-78 1988; 
• 16 Merabet E, Dagogo-Jack S, Coyne D W, Klein S, Santiago J V, Hmiel P, Landt M. Increased plasma leptin concentration in end-stage renal disease.  J Clin Endocrinol Metab. 82 847-850 1997; 
• 17 Meyer C, Robson D, Rackovsky N, Nadkarni V, Gerich J. Role of the kidney in human leptin metabolism.  Am J Physiol. 273 E903-E907 1997; 
• 18 Muscelli E, Camastra S, Masoni A, Baldi S, Sironi M, Natal A, Ferrannini E. Acute insulin administration does not affect plasma leptin levels in lean or obese subjects.  Eur J Clin Invest. 26 940-943 1996; 
• 19 Nordfors L, Lönnqvist F, Heimbürger O, Danielsson A, Schalling M, Steinvinkel P. Low leptin gene expression and hyperleptinemia in chronic renal failure.  Kidney Int. 54 1267-1275 1998; 
• 20 Odamaki M, Furuya R, Yoneyama T, Nishikino M, Hibi I, Miyaji K, Kumagai H. Association of the serum leptin concentration with weight loss in chronic hemodialysis patients.  Am J Kidney Dis. 33 361-368 1999; 
• 21 Pinkey J H, Coppack S W, Mohamed-Ali V. Effect of isoprenaline on plasma leptin and lipolysis in humans.  Clin Endocrinol. 48 407-411 1998; 
• 22 Reaich D, Channon S M, Scrimgeour C M, Daley S E, Wilkinson R, Goodship T HJ. Correction of acidosis in humans with CRF decreases protein degradation and amino acids oxidation.  Am J Physiol. 265 E230-E235 1993; 
• 23 Steinvinkel P, Heimbürger O, Lönnqvist F. Serum leptin concentations correlate to plasma insulin concentrations independent of body fat content in chronic renal failure.  Nephrol Dial Transplant. 12 1321-1325 1997; 
• 24 Teta D, Bevington A, Brown J, Throssell D, Harris K P, Walls J. Effects of acidosis on leptin secretion from 3T3-L1 adipocytes and on serum leptin in the uraemic rats.  Clin Sci (Colch). 97 363-368 1999; 
• 25 Teta D, Bevington A, Brown J, Walls J. Responses of leptin to acidosis: a glucose dependent effect.  Nephrol Dial Transplant. 15 A22 2000; 
• 26 Wabitsch M, Jensen P B, Blum W F, Christoffersen C T, Englaro P, Heinze E, Rasher W, Teller W, Tornqvist H, Hauner H. Insulin and cortisol promote leptin production in cultured human fat cells.  Diabetes. 45 1435-1438 1996; 
• 27 Whittaker J, Cuthbert C, Hammond V A, Alberti K G. The effects of metabolic acidosis in vivo on insulin binding to isolated rat adipocytes.  Metabolism. 31 553-557 1982; 
• 28 Young G A, Woodrow G, Kendall S, Oldroyd B, Turney A, Brownjohn A M, Smith M A. Increased plasma leptin/fat ratio in patients with chronic renal failure: A cause of malnutrition?.  Nephrol Dial Transplant. 12 2318-2323 1997;