Parathyroidectomy And Serum Leptin Levels In Stage5Chronic Kidney Disease Patients

Objective:Serum leptin is related to bone-mineral metabolism, hematopoiesis and nutritional indexes in stage5chronic kidney disease(CKD) patients. However, the change of serum leptin level in stage5CKD patients compared to healthy controls is controversial. This study aimed to evaluate the correlation between serum leptin with clinical and blood biochemical parameters and longitudinal changes of serum leptin after parathyroidectomy (PTX) in stage5CKD patients.Methodology:We investigated113stable stage5CKD patients,76controls and a prospective study in two subgroups classified as successful (n=23), unsuccessful (n=4) PTX follow-up enrolled from March2011to October2013. Clinical characteristics, biochemical indices, and serum leptin were analyzed.Results:There is no difference between serum lg(leptin)(log10leptin) level (3.7±0.4vs.3.7±0.6) in stage5CKD patients and healthy subjects. Serum lg(leptin) concentration is positive with age (r=0.52, P=0.003) and body mass index (BMI)(r=0.69,P<0.001) in healthy men; BMI (r=0.47, P=0.001) in healthy women. Serum lg(leptin) is negative with albumin (r=-0.45, P=0.011) in healthy men. Serum lg(leptin) concentration in patients with stage5CKD has correlated positively with BMI (r=0.43, P<0.001), serum glucose (r=0.31, P=0.013), serum triglyceride (r=0.27, P=0.031), serum albumin (r=0.30, P=0.018) in males; serum lg(leptin) has corrected positively with BMI (r=0.51, P<0.001), hemoglobin(r=0.36, P=0.010), hematocrit (r=0.32, P=0.024) and serum triglyceride (r=0.36, P=0.010) in females. However, serum lg(leptin) has negative relationship with serum high density lipoprotein (HDL)(r=-0.49,/><0.001) and log10intact parathyroid hormone (lg(iPTH))(r=-0.27, P=0.035) in males; serum HDL (r=-0.36, P=0.009) in females. Compared with baseline, the successful PTX subgroup has significant improvement in weight (59.1±14.0kg vs.60.7±14.1kg, P=0.019), hemoglobin (102.1±18.3g/L vs.122.8±16.4g/L, P<0.001), hematocrit (31.9±5.4%vs.38.5±5.2%, P<0.001), serum triglyceride (1.5±0.54mmol/L vs.1.9±0.9mmol/L, P=0.038), serum albumin (38.2±2.9g/L vs.45.3±4.0g/L, P<0.001), serum calcium (10.1±1.0mg/dl vs.8.1±1.0mg/dl, P<0001), serum phosphorus (8.9±2.8mg/dl vs.4.4±1.8mg/dl, P<0.001), serum alkaline phosphates (708.1±550.2u/1vs.217.6±172.0u/1, P<0.001), serum lg(iPTH)(3.3±0.2vs.1.8±0.5, P<0.001) and serum lg(leptin)(3.8±0.5vs.3.9±0.4, P=0.038) with a median follow-up of5.70months. Increased serum lg(leptin) change is positively related to increased weight change (r=0.44, P=0.032), increased hemoglobin change (r=0.55, P=0.007), increased hematocrit change (r=0.51, P=0.013) and decreased serum lg(iPTH) change (r=0.44, P=0.034) in successful PTX group. Except an increase in serum albumin (36.4±2.8g/L vs.45.8±3.8g/L, P=0.009), there was no significant change of serum lg(leptin) level and other biochemical indexes in secondary hyperparathyroidism patients after unsuccessful PTX with a median follow-up of5.65months.Conclusion:Serum lg(leptin) level has no significant difference between stage5CKD patients and health subjects. Serum lg(leptin) level is associated with bone-mineral metabolism, hematopoiesis and nutritional indexes in stage5CKD patients. The correlation between the changes of postoperative serum lg(leptin), clinical and blood biochemical indexes in successful PTX group could explain that increased serum lg(leptin) is beneficial to improve nutrition, anemia and bone-mineral metabolism in successful PTX group. This provide a new idea for profound research in the future to explore the meaning of leptin to CKD patients.