Bales Alessandra M, Moysés Rosa M A, dos Reis Luciene M, Graciolli Fabiana G, Hung James, Martins Castro Manuel Carlos, Elias Rosilene M
Division of Nephrology, Hospital das Clinicas da FMUSP - Disciplina de Nefrologia, Universidade de São Paulo, Rua Dr. Enéas de Carvalho Aguiar 255, 7º andar, São Paulo, SP, CEP 05403-000, Brazil.
Int Urol Nephrol. 2015 Jan;47(1):177-82. doi: 10.1007/s11255-014-0844-5. Epub 2014 Sep 25.
Hyperleptinemia and metabolic acidosis (MA) are frequently observed in patients on hemodialysis (HD). While the role of leptin in patients on HD is not completely understood, HD only partially corrects MA. Both leptin and acidosis have effect on bone disease. The goal of the present study was to evaluate the effects of MA correction on chronic kidney disease-mineral and bone disorder laboratory parameters and leptin levels.
Forty-eight patients on HD, aged 43±19 years, were prospectively studied. Individual adjustments in the bicarbonate dialysate concentration were made to maintain pre-dialysis concentration≥22 mEq/l. Blood gas analysis was done monthly for 4 months (M1-M4).
From M0 to M4, serum albumin increased (from 3.5 ±0.3 to 4.0±0.3 g/l, p<0.0001) while β2 microglobulin decreased (from 27.6±8.3 to 25.8±6.8 µg/ml, p=0.025). Serum leptin decreased in all but three patients, as well as leptin/adiponectin ratio (p<0.0001). There was a decrease in ionized serum calcium (from 5.0±0.5 to 4.7±0.5 mg/dl, p =0.002) and an increase in parathyroid hormone (PTH) [from 191 (85, 459) to 446 pg/ml (212, 983), p<0.0001] and in serum phosphate (from 5.4±1.4 to 5.8±1.1 mg/dl, p=0.048).
MA correction in HD patients can decrease leptin, an atherogenic marker. The impact of such treatment extends to uremic bone disease, as decrease in serum calcium and increase in PTH. However, this could be an undesirable effect because it may aggravate a secondary hyperparathyroidism. Whether the reduction in leptin levels has impact on outcomes in patients on hemodialysis deserves further investigation.
血液透析（HD）患者中高瘦素血症和代谢性酸中毒（MA）较为常见。虽然瘦素在HD患者中的作用尚未完全明确，但HD仅能部分纠正MA。瘦素和酸中毒均对骨病有影响。本研究的目的是评估MA纠正对慢性肾脏病 - 矿物质和骨异常实验室参数及瘦素水平的影响。
对48例年龄为43±19岁的HD患者进行前瞻性研究。对碳酸氢盐透析液浓度进行个体化调整，以维持透析前浓度≥22 mEq/l。连续4个月（M1 - M4）每月进行一次血气分析。
从M0到M4，血清白蛋白增加（从3.5±0.3增至4.0±0.3 g/l，p<0.0001），而β2微球蛋白降低（从27.6±8.3降至25.8±6.8 μg/ml，p = 0.025）。除3例患者外，所有患者的血清瘦素均下降，瘦素/脂联素比值也下降（p<0.0001）。血清离子钙降低（从5.0±0.5降至4.7±0.5 mg/dl，p = 0.002），甲状旁腺激素（PTH）升高[从191（85, 459）升至446 pg/ml（212, 983），p<0.0001]，血清磷酸盐升高（从5.4±1.4升至5.8±1.1 mg/dl，p = 0.048）。
HD患者MA的纠正可降低瘦素水平，瘦素是一种致动脉粥样硬化标志物。这种治疗的影响还扩展到尿毒症骨病，表现为血清钙降低和PTH升高。然而，这可能是一种不良影响，因为它可能会加重继发性甲状旁腺功能亢进。瘦素水平降低对血液透析患者预后的影响值得进一步研究。
