Abstract: SA-PO166

Leptin Levels Are Not Reduced by High-Flux Compared with Low-Flux Haemodialysis: Results of a Randomized Trial

Session Information

Category: Nutrition, Inflammation, and Metabolism

  • 1401 Nutrition, Inflammation, Metabolism

Authors

  • Schneider, Andreas, University of Wuerzburg, Wuerzburg, Germany
  • Schneider, Markus P., University of Erlangen-Nuremberg, Erlangen, Germany
  • Krieter, Detlef H., University Hospital Würzburg, Würzburg, Germany
  • Scharnagl, Hubert, Medical University of Graz, Graz, Austria
  • Wanner, Christoph, University Hospital Wuerzburg, Wuerzburg, Germany
  • Drechsler, Christiane, University Hospital Wuerzburg, Wuerzburg, Germany
Background

Leptin, in addition to its well described effects on glucose homeostasis, might be directly involved in the progression of atherosclerosis, as it promotes chronic inflammation and vascular smooth muscle cell proliferation. Interestingly, leptin levels are significantly increased in haemodialysis (HD) patients compared with healthy controls. Interventional strategies able to reduce levels of leptin in HD patients are of particular interest. The low molecular weight of leptin (16 kD) suggests that its elimination might depend on the specific HD modality.

Methods

We performed a randomized controlled trial on the effects of high-flux versus low-flux HD. 127 maintenance HD patients were randomized to low-flux (n=62) or high-flux (n=65) HD for 52 weeks. The primary endpoint of the study was the effect on parameters of anaemia, which has been published previously. The secondary endpoint included the effect on leptin levels. Leptin levels were measured by ELISA at baseline and after 52 weeks of treatment.

Results

Patients in both groups were 66 years (mean age). Underlying kidney disease was diabetic nephropathy in most cases (28% in the low-flux group and 38% in the high-flux group).
Compared to baseline, a significant increase in leptin levels after one year of low-flux HD was observed (Delta leptin 41.7 ng/ml; p=0.032). In contrast, leptin levels remained more stable in the high flux group (Delta leptin 32.8 ng/ml; p=0.062). However, there was no difference in absolute change of leptin levels over time between the two randomization groups (p=0.743).

Conclusion

In this randomized controlled trial, we found that leptin levels increased after one year in patients allocated to low-flux HD, but remained more stable in those allocated to high-flux HD. However, the lack of a significant treatment difference suggests that high-flux HD is not more effective than low-flux HD. Future studies should investigate whether enhanced convective solute transport (e.g. by haemodiafiltration) would be able to improve leptin removal and patient outcome.