Nanayakkara P W P, Le Poole C Y, Fouque D, van Guldener C, Stehouwer C D A, Smulders Y M, van Ittersum F J, Siegert C E H, Drai J, Kostense P J, ter Wee P M
Department of Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands.
Clin Nephrol. 2009 Jul;72(1):21-30. doi: 10.5414/cnp72021.
Chronic kidney disease (CKD) is associated with an increased incidence of cardiovascular disease (CVD). A few studies have demonstrated elevated plasma adiponectin and leptin levels in CKD. The aims of this study were to assess whether 1) estimated glomerular filtration rate (eGFR) is associated with plasma leptin and adiponectin; and 2) adiponectin and leptin (partly) explain associations of CKD with endothelial dysfunction, insulin resistance, and low-grade inflammation in patients with K/DOQI Stage 3 - 5 CKD.
Baseline data from 91 patients with Stage 3 - 4 CKD in the anti-oxidant therapy in chronic renal insufficiency study, a randomized, double-blind, placebo-controlled trial, in which the effects of oxidative stress-lowering treatment on vascular function and structure were studied, and from 50 dialysis naïve patients, who took part in an open-label, randomized study that compared two peritoneal dialysis regimens, used in the analysis. All subjects for both the studies were recruited in the same centres.
The association between eGFR and adiponectin was non-linear. In multivariate analysis, log-eGFR (unstandardized beta = 8.303 microg/ml, p < 0.0001) was the strongest determinant of adiponectin, and body mass index the strongest determinant of leptin (beta = 2.477 ng/ml, p < 0.0001). Plasma adiponectin and leptin did not modify the associations between eGFR and plasma von Willebrand factor or soluble vascular adhesion molecule-1. Plasma leptin had the strongest association with the homeostatic model assessment (HOMA-IR) index. Plasma C-reactive protein had no association with adiponectin or leptin.
In patients with K/DOQI Stage 3 - 5 CKD, renal function had a significant non-linear inverse association with and was the strongest predictor of adiponectin. BMI was the strongest predictor of plasma leptin. Plasma adiponectin and leptin did not explain, and thus presumably are not involved in, the association between eGFR and some markers of endothelial dysfunction.
慢性肾脏病（CKD）与心血管疾病（CVD）发病率增加相关。一些研究已证实CKD患者血浆脂联素和瘦素水平升高。本研究的目的是评估：1）估计肾小球滤过率（eGFR）是否与血浆瘦素和脂联素相关；2）脂联素和瘦素是否（部分）解释了CKD与K/DOQI 3 - 5期CKD患者内皮功能障碍、胰岛素抵抗和低度炎症之间的关联。
在慢性肾功能不全抗氧化治疗研究中，选取91例3 - 4期CKD患者的基线数据，该研究为一项随机、双盲、安慰剂对照试验，旨在研究降低氧化应激治疗对血管功能和结构的影响；另外选取50例未接受透析的患者，他们参与了一项开放标签、随机研究，该研究比较了两种腹膜透析方案，所有研究对象均在同一中心招募，将这些数据用于分析。
eGFR与脂联素之间的关联是非线性的。在多变量分析中，log - eGFR（未标准化β = 8.303μg/ml，p < 0.0001）是脂联素的最强决定因素，而体重指数是瘦素的最强决定因素（β = 2.477ng/ml，p < 0.0001）。血浆脂联素和瘦素并未改变eGFR与血浆血管性血友病因子或可溶性血管细胞黏附分子 - 1之间的关联。血浆瘦素与稳态模型评估（HOMA - IR）指数的关联最强。血浆C反应蛋白与脂联素或瘦素无关联。
在K/DOQI 3 - 5期CKD患者中，肾功能与脂联素呈显著非线性负相关，且是脂联素的最强预测因素。BMI是血浆瘦素的最强预测因素。血浆脂联素和瘦素无法解释，因此可能未参与eGFR与一些内皮功能障碍标志物之间的关联。
