Leptin and Adiponectin as Uremic Adipokines: Associations with Survival in a Prospective Hemodialysis Cohort
Year: 2025
Type: article
Abstract: BACKGROUND: While experimental models show that leptin and adiponectin have inverse effects on the cardiovascular system, it has been suggested that the leptin-to-adiponectin (L/A) ratio may be an important predictor of cardiovascular disease and death. Higher circulating leptin and adiponectin levels are observed in uremia due to decreased renal degradation and/or clearance and increased production. We sought to examine the association between the L/A ratio and mortality in a prospective hemodialysis cohort. METHODS: Among a prospective cohort of 448 hemodialysis patients from the NIH "Malnutrition, Diet, and Racial Disparities in Chronic Kidney Disease (CKD) (MADRAD) study who underwent leptin and adiponectin measurements, we examined characteristics associated with high leptin and adiponectin (defined as the highest tertile) using logistic regression. We then examined the association of L/A ratio levels (categorized as tertiles) with all-cause mortality using Cox regression. RESULTS: Multivariable logistic regression analyses showed female sex, diabetes, presence of an arteriovenous fistula/graft, and lower serum albumin, IL-6, and adiponectin were associated with high leptin, whereas female sex, longer vintage, Black race, higher IL-6, and lower leptin were associated with high adiponectin. When examining L/A ratios, the highest tertile was associated with lower mortality in case-mix Cox models (ref: lowest tertile): HR (95% CI) 0.14 (0.06-0.35). These associations were robust in analyses that additionally adjusted for laboratory covariates: (HR 95% CI) 0.18 (0.07-0.46). CONCLUSIONS: In a prospective cohort of hemodialysis patients, inflammation and malnutrition markers were associated with lower leptin and higher adiponectin levels. Additionally, high L/A ratio levels were associated with lower mortality. Further studies are needed to determine the mechanisms relating adipocytokines, inflammation and nutrition, and survival in this population.
Source: Toxins
Authors: Thuy-Anh V. Bui, Amy S. You, Sara S. Kalantar, Jihoon Yoon, Yoko Narasaki, John Sy, Ramy Hanna, Andrea Daza, Yalitzi Guerrero, Anyssa Dang, Ria Arora, Danh V. Nguyen, Kamyar Kalantar-Zadeh, Connie M. Rhee
Institutions: Baylor College of Medicine, University of California, Irvine, University of California, Los Angeles, University of California, Berkeley, VA Greater Los Angeles Healthcare System, Columbia University, Barnard College, The Lundquist Institute, Tibor Rubin VA Medical Center, VA Long Beach Healthcare System
Language: English
Subfield: Nephrology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,258
Awards: Defining Optimal Transitions of Care in Advanced Kidney Disease: Conservative Management vs. Dialysis Approaches, G2192468904, A Randomized Controlled Trial of Thyroid Hormone Supplementation in Hemodialysis Patients, G3883722926, G444023444, MALNUTRITION, DIET AND RACIAL DISPARITIES IN CKD, Continuous Glucose Monitoring in Dialysis Patients to Overcome Dysglycemia (CONDOR) Trial, Multilevel Time-Dynamic Modeling of Hospitalization and Survival in Patients on Dialysis, G963468406
OpenAlex ID: W4415648078