Grzegorzewska A E, Wiecek A, Mariak I, Kokot F
Department of Nephrology, Karol Marcinkowski University of Medical Sciences, Poznan, Poland.
Adv Perit Dial. 2000;16:7-14.
In continuous ambulatory peritoneal dialysis (CAPD) patients, nutritional parameters, appetite, and transperitoneal solute movement can be modified by treatment with amino-acid-based dialysis solution (AADS). Because leptin is involved in energy expenditure and appetite regulation, we decided to examine the influence of AADS on serum and dialysate leptin concentrations. We prospectively evaluated AADS influence on leptinemia and peritoneal transport indices in CAPD patients. Nine clinically stable patients (7 males, 2 females), mean age 55.4 +/- 10.5 years, who had been treated with CAPD for 6.1 +/- 5.8 months, were studied. Examinations were conducted before treatment with 1.1% AADS (period I), after 3 months of AADS administration (period II), after 6 months of AADS administration (period III), and at 3 months after AADS discontinuation (period IV). The primary outcome measure was concentration of leptin in serum and dialysate. Secondary measures included anorexia incidence, nutrient intake, and nutritional parameters. Dialysate-to-plasma ratio (D/P), peritoneal excretion, and clearance (PCl) of leptin were calculated. After 3 months of AADS administration (period II), leptinemia was transiently lower (9.8 +/- 6.2 ng/mL vs 17.1 +/- 14.2 ng/mL, p = 0.017), while D/P (0.51 +/- 0.44 vs 0.23 +/- 0.19, p = 0.012), peritoneal excretion (72.9 +/- 85.4 micrograms/day vs 37.2 +/- 32.3 micrograms/day, p = 0.015), and PCl (4.02 +/- 3.40 mL/min vs 1.75 +/- 1.32 mL/min, p = 0.008) of leptin were higher than measurements obtained at entry. Anorexia incidence and daily protein and energy intakes showed no significant changes during the study. Total body mass, body mass index, and plasma concentrations of total protein and of albumin increased significantly during AADS treatment. A significant positive relation of leptinemia to total fat mass was observed when AADS was not used (periods I and IV). We conclude that administration of AADS in CAPD patients causes a transient decrease in leptinemia and increases in peritoneal excretion and in PCl of leptin, as well as dissociation of the physiological relationship between serum leptin level and total fat mass.
在持续性非卧床腹膜透析（CAPD）患者中，基于氨基酸的透析液（AADS）治疗可改变营养参数、食欲和经腹膜溶质转运。由于瘦素参与能量消耗和食欲调节，我们决定研究AADS对血清和透析液中瘦素浓度的影响。我们前瞻性评估了AADS对CAPD患者瘦素血症和腹膜转运指标的影响。研究对象为9例临床稳定的患者（7例男性，2例女性），平均年龄55.4±10.5岁，已接受CAPD治疗6.1±5.8个月。在使用1.1% AADS治疗前（I期）、AADS给药3个月后（II期）、AADS给药6个月后（III期）以及AADS停药3个月后（IV期）进行检查。主要观察指标为血清和透析液中瘦素的浓度。次要指标包括厌食发生率、营养摄入和营养参数。计算瘦素的透析液与血浆比值（D/P）、腹膜排泄率和清除率（PCl）。AADS给药3个月后（II期），瘦素血症暂时降低（9.8±6.2 ng/mL对17.1±14.2 ng/mL，p = 0.017），而瘦素的D/P（0.51±0.44对0.23±0.19，p = 0.012）、腹膜排泄率（72.9±85.4微克/天对37.2±32.3微克/天，p = 0.015）和PCl（4.02±3.40 mL/min对1.75±1.32 mL/min，p = 0.008）高于入组时的测量值。在研究期间，厌食发生率以及每日蛋白质和能量摄入量无显著变化。在AADS治疗期间，总体重、体重指数以及总蛋白和白蛋白的血浆浓度显著增加。在未使用AADS时（I期和IV期），观察到瘦素血症与总脂肪量之间存在显著正相关。我们得出结论，在CAPD患者中给予AADS会导致瘦素血症暂时降低，瘦素的腹膜排泄率和PCl增加，以及血清瘦素水平与总脂肪量之间的生理关系解离。
