Leptin/Adiponectin Ratio is an Independent Predictor of Mortality in Nondiabetic Peritoneal Dialysis Patients

Abstract

♦Background The leptin/adiponectin (L/A) ratio has been suggested to be an atherosclerotic index for diabetic patients and a useful marker of insulin resistance in patients with and without diabetes. Even though end-stage renal disease (ESRD) patients on peritoneal dialysis (PD) are well characterized by abnormal adipocytokine metabolism, the significance of alterations in the L/A ratio is largely unexplored in these patients. In this prospective study, we investigated the associations of leptin, adiponectin, and the L/A ratio with clinical outcomes in nondiabetic PD patients. ♦Methods The study included 131 stable nondiabetic ESRD patients who had been on PD for more than 3 months. Serum leptin and adiponectin levels were determined at baseline. Mortality was evaluated over a 5-year follow-up period. ♦Results During the follow-up period, 22 patients died (16.8%), including 10 (45.5%) as a result of cardiovascular disease. The L/A ratio showed a significant positive correlation with body mass index [BMI ( r = 0.47, p < 0.001)], high-sensitivity C-reactive protein ( r = 0.32, p < 0.001), and triglycerides ( r = 0.43, p < 0.001). In addition, we observed significant inverse correlations between the L/A ratio and percentage lean body mass ( r = –0.30, p = 0.001) and high-density lipoprotein cholesterol ( r = –0.31, p = 0.001). In contrast to individual leptin and adiponectin levels, the L/A ratio was found to be independently associated with an increased mortality risk (relative risk: 1.15; 95% confidence interval: 1.05 to 1.27; p = 0.003) even after adjustments for age and BMI. ♦Conclusions The L/A ratio might be better related to patient outcomes than adipocytokines are individually in nondiabetic patients undergoing PD.