Abi Nanzha, Xu Xiao, Yang Zhikai, Ma Tiantian, Dong Jie
Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China.
Institute of Nephrology, Peking University, Beijing, China.
Front Nutr. 2022 Mar 15;9:828341. doi: 10.3389/fnut.2022.828341. eCollection 2022.
Metabolic disorders are prevalent in patients with chronic kidney disease (CKD) and may lead to protein energy wasting (PEW). Adipokines improve connections between PEW and energy metabolism. We aimed to determine the relationship between adipokine levels and resting energy expenditure (REE) in patients with CKD.
A total of 208 patients in non-dialyzed CKD stages 3-5 were enrolled in this cross-sectional study. Serum adipokines (leptin, adiponectin, and interleukin 6 (IL-6) were measured using enzyme-linked immunosorbent assay. Patient's REE was measured using indirect calorimetry. Fat mass (FM) and lean tissue mass (LTM) were measured using multiple-frequency bioimpedance analysis. Spearman correlation analyses and multivariate linear regression models were used to assess the association between serum adipokines and REE.
The mean age was 52.7 ± 14.6 years, and 26.9, 26.4, and 46.7% of our participants had CKD stages 3, 4, and 5, respectively. The median values of serum adiponectin, leptin, and IL-6 were 470.4 (range, 291.1-802.2), 238.1 (range, 187.9-418.4), and 4.0 (range, 2.4-9.5) pg/mL, respectively. The male participants had significantly lower FM% ( = 0.001) and lower leptin levels ( < 0.001) than the female participants. After adjusting for age, diabetes, high-sensitivity C-reactive protein, intact parathyroid hormone, LTM, and FM, multiple linear regression analysis revealed that serum leptin levels were significantly positively associated with REE in men rather than in women ( < 0.05). Serum adiponectin levels were inversely associated with REE in men, but this association disappeared while FM was additionally adjusted. Adiponectin levels in women were not correlated with REE ( > 0.05). IL-6 was not significantly associated with REE in either men or women.
A sex-specific relationship between serum adipokines (leptin and adiponectin) and REE was observed in patients with CKD stages 3-5, which was partly confounded by FM.
代谢紊乱在慢性肾脏病（CKD）患者中普遍存在，可能导致蛋白质能量消耗（PEW）。脂肪因子改善了PEW与能量代谢之间的联系。我们旨在确定CKD患者脂肪因子水平与静息能量消耗（REE）之间的关系。
本横断面研究共纳入208例3-5期非透析CKD患者。采用酶联免疫吸附测定法检测血清脂肪因子（瘦素、脂联素和白细胞介素6（IL-6））。采用间接测热法测量患者的REE。采用多频生物电阻抗分析法测量脂肪量（FM）和瘦组织量（LTM）。采用Spearman相关分析和多元线性回归模型评估血清脂肪因子与REE之间的关联。
平均年龄为52.7±14.6岁，分别有26.9%、26.4%和46.7%的参与者处于CKD 3期、4期和5期。血清脂联素、瘦素和IL-6的中位数分别为470.4（范围：291.1-802.2）、238.1（范围：187.9-418.4）和4.0（范围：2.4-9.5）pg/mL。男性参与者的FM%显著低于女性（P=0.001），瘦素水平也低于女性（P<0.001）。在调整年龄、糖尿病、高敏C反应蛋白、全段甲状旁腺激素、LTM和FM后，多元线性回归分析显示，血清瘦素水平在男性而非女性中与REE显著正相关（P<0.05）。男性血清脂联素水平与REE呈负相关，但在额外调整FM后，这种关联消失。女性脂联素水平与REE无相关性（P>0.05）。IL-6在男性和女性中均与REE无显著相关性。
在3-5期CKD患者中观察到血清脂肪因子（瘦素和脂联素）与REE之间存在性别特异性关系，部分受FM影响。
