The effect of serum leptin levels on inflammatory markers and carotis intima media thickness among peritoneal dialysis patients

SUMMARYThe Effect of Serum Leptin Levels onInflammatory Markers and Carotis Intima Media ThicknessAmong Peritoneal Dialysis PatientsBahceli, Sakine.Department of Internal Medicine, School of Medicine, Dokuz Eylül University zmirAddress for correspondence: DEUTF Iç Hastalıkları A.D Inciraltı/Izmir 35340e-mail: sakine_bahceli2003@yahoo.comAim: The relative risk of death from cardiovascular disease (CVD) when compared tothe general population has been found 10 to 20 times more in patients with chronic renalfailure (CRF); it has also been found that the annual mortality rate is %9 because of CVD. Thisrisk can be a result of ?accelerated atherosclerosis? in end stage renal disease (ESRD). Deathsfrom CVD have been found increased in the first few years of dialysis. This makes us thinkthat the dialysis alone can be responsible for accelerated atherosclerosis. It is also been thoughtthat in CVD patients there can be some new risk factors which can be unidentifiable in generalpopulation other than known the traditional and nontraditional risk factors. Here are someinteresting defined risk factors; increased oxidative stress, hyperhomocysteinemia andcontinuous inflammation. Recent studies demonstrate increased serum leptin levels in CRFpatients. Leptin is a peptide kind of structured cytokine that is about 16 kD and synthesized andsecreted by adipose tissues. It has been shown that there is a positive correlation between theserum leptin levels and inflammatory markers in both obese and non-obese humans. In thisstudy, we tried to identify a relation between increased serum leptin levels and acceleratedatherosclerosis in peritoneal dialysis patients (PD). To demonstrate this relationship; thecorrelation between serum leptin levels, inflammatory markers and carotid artery intima mediathickness (which is an indirect indicator of atherosclerosis) in PD patients was evaluted. AlsoPD patients were compared to healthy controls in respect of these parameters.Material and Method: This is a case control study. Twenty seven PD patients and 25healthy controls that had similar characteristics (age, gender and body mass index) withpatients were included. Serum leptin, insulin, hs-CRP, albumin, prealbumin and plasmafibrinogen levels were measured. Body mass index (BMI) and body fat percentage of patientswas calculated. Carotid artery Doppler ultrasonography was performed and CIMT wasmeasured. Also existence of calcific atherosclerotic plaques was noted.Results: A significant difference between both groups with respect to serum leptin,insulin levels and inflammatory markers (hs-CRP, albumin, prealbumin, fibrinogen) had beenfound (p values 0.000, 0.007, 0.000, 0.000, 0.000, 0.000, respectively). PD patients hadsignificantly more possibility to have a calcific atherosclerotic plaques compared to healthycontrols (p:0.038); however CIMT was not significantly different in both groups (p: 0.758). Inthis study, a correlation between CIMT and serum leptin level with inflammatory markers inpatients could not be shown.Conclusion: Despite the number of patients was low, it is possible to conclude that thereis a relation between serum leptin levels and existence of a calcific atherosclerotic plaques.However, among patients a relationship between serum leptins levels, CIMT, andinflammatory markers could not be demostrated.Key Words: Leptin, atherosclerosis, inflammatory markers, end stage renal disease,peritoneal dialysis, intima-media thickness.