Serum leptin in end-stage renal disease patients on hemodialysis: its value as a malnutrition marker

Leptin is a protein hormone secreted by adipocytes in proportion to the amount of body fat and exerts sustained inhibitory effects on food intake while increasing energy expenditure. It has been reported that serum leptin levels are high in patients with chronic renal failure and may have a potential impact on the development of uremic cachexia. The present study aimed to evaluate serum leptin level and its relation to markers of malnutrition in non diabetic patients with end-stage renal disease [ESRD] treated with hemodialysis. Serum leptin level was measured in 48 ESRD patients [30 males and 18 females] on regular hemodialysis, and in 20 healthy control subjects. The nutritional status was checked by anthropometric measurements [body mass index [BMI] and triceps skin fold thickness [TSFT]] and laboratory data [hemoglobin, hematocrite, serum albumin, pre-albumin, total protein, and blood urea nitrogen]. Patients were included if they were on hemodialysis for more than one year, anuric, had normal C reactive protein values and had no history of diabetes mellitus, liver disease or chronic pulmonary disorders. The mean serum leptin level was higher in ESRD patients [28.5 +/- 15.3ng/ml] compared to the control [5.2 +/- 3.8ng/ml; P<0.001]. The indices of hematological and protein-energy malnutrition were evident in hemodialysed patients compared to controls. The mean serum leptin was significantly higher in male patients compared to the male control group [11.5 +/- 4.7 vs 3.2 +/- 2.1ng/ml, P<0.01]. Also, serum leptin was significantly higher in the female patients compared to the female control group [35.8 +/- 12.1 vs 12.7 +/- 4.5ng/ml, P<0.001]. The mean BMI for female patients was significantly higher than male patients [24.4 +/- 4.1 vs 21.1 +/- 5.6kg/m2, P<0.04]. The mean TSFT for female patients was significantly higher than male patients [13.8 +/- 3.2 vs 10.7 +/- 2.2mm, P<0.05]. A positive correlation was found between the TSFT and leptin, both in male [r=0.44, P<0.03] and female patients [r=0.71, P<0.01]. Also, there was a positive correlation between the BMI and leptin both in male [r=0.41, P<0.02] and female patients [r=0.67, P<0.01]. No correlation was observed between serum leptin with the length of time on dialysis, total protein, serum albumin, pre-albumin, hemoglobin, hematocrite, creatinine and blood urea levels. Serum leptin is markedly elevated in patients with ESRD on hemodialysis. It is significantly correlated with the BMI and TSFT and could be utilized as a potential indicator of malnutrition in these patients. Further studies may provide a therapeutical approach aiming to neutralize serum leptin levels or blocking its effect on the hypothalamus to prevent uremia-associated malnutrition

Total and LDL combined vitamin E concentrations in plasma patient with non insulin dependent diabetes mellitus

Patients with diabetes mellitus are susceptible to oxidant-antioxidant imbalance. Diabetic complications such as nephropathy, neuropathy and retinopathy increase 'this susceptibility. Other traditional atherogenic risk factors such as hypertension, cigarette smoking and dyslipidemia can also induce oxidant stress. It is possible that the existence of two or more of the atherogenic risk factors may enhance oxidant-antioxidant imbalance. However, this proposal has not been fully studied. Aim: To determine plasma vitamin E concentrations, both total and the fraction within LDL particles in patients with sole noninsulin-dependent diabetes mellitus [N-1DDM] or N1DDM associated with one or more of the other risk factors of atherosclerosis. This study was conducted on 60 patients with NIDDM [32 males and 28 females]. They were classified into four groups: [1] sole diabetic [n=20], [2] diabetic-hypertensive [n=10], [3] cigarette smoking diabetic [n=10] and [4] diabetic with multiple atherogenic risk factors [n=20]. Also, twenty clinically healthy individuals were investigated as a control group. Vitamin E was measured by high performance liquid chromatography [HPLC] while a plasma thiobarbituric acid reactive substance [malondialde-hyde] was determined colorimetrically. Plasma total vitamin E [VE] and vitamin E in LDL [VE-LDL] concentrations were significantly decreased while plasma malondialdehyde [MDA] levels were significantly increased in sole N1DDM, diabetic hypertensive, smoking diabetic and diabetic with multiple atherogenic risk factors groups in comparison to the corresponding values of the control group. These changes were noted more frequently and more severely in patients with multiple risk factors than those with single DM or DM with another risk factor. In these groups, vitamin E content in HDL showed significant negative correlation with LDL-C concentrations and significant positive correlation with HDL-C concentrations. Multiple regression analysis showed that vitamin E in HDL particles was an independent risk factor for coronary heart disease. The subnormal vitamin E content in LDL panicles may be a result of enhanced LDL oxidation in patients

Vascular endothelial growth factor [VEGF]: an association with diabetic microvascular complications

Type 2 diabetes mellitus [DM] and hyperhomocysteinaemia are both associated with premature vascular disease. This study aimed to assess plasma total homocysteine [P tHcy] level in type 2DM and its relation to nephropathy and retinopathy. P tHcy level was estimated in 20 type 2 diabetic patients with retinopathy and microalbuminuria and 20 patients with retinopathy and macroalbuminuria versus 20 type 2 diabetics with no retinopathy nor nephropathy and 20 healthy controls matched for age, sex and race. Other assessment included funduscopic examination, complete urine analysis, estimation of urinary albumin excretion rate, blood urea, serum creatinine, crentinine clearance, fasting plasma glucose, glycosylated haemoglobin [HbA[IC]]. serum lipid profile. as well as ultrasonographic examination of the kidneys and renal arteries. Mean P tHcy concentration was significantly higher in both the albuminuric groups than in normal albuminuric. group and controls, however mean P tHcy was inversely correlated with creatinine clearance versus no correlation with the other studied parameters, and no relation to retinopathy. Creatinine clearance is the only parameter associated with P tHcy, denoting that the degree of renal functional impairment is the determinant of its plasma concentration in patients with type 2 DM

study of diabetic and non-diabetic neuropathies in diabtic patients: the magnitude of the problem

The epidemiology of diabetic and non-diabetic neuropathies in diabetic patients is important for agreement over its diagnostics criteria. The present study aimed to put the diagnostic criteria for both neuropathies in diabetic patients. The study comprised 60 diabetic patients with symptomatic neuropathy [40 males and 20 females] with age ranged from 21 to 82 year. They were subdivided into 2 subgroups, according to type of their diabetes, group 1 [45 patients with II DM] group 2 [15 patients with type I DM]. They were evaluated in order to know more about the cause of neuropathy in this population and the signs and symptoms that could suggest other cause than diabetes in this sitting. Diabetes accounted for [75%] of the neuropathies in the whole group of patients while twenty-five percent [25%] of patients have a neuropathy unrelated to diabetes. Chronic inflammatory demyelinating neuropathy that was diagnosed in 10%is the most common non-diabetic cause of neuropathy within population. A short interval between diagnosis of diabetes and the onset of the neuropathy, early motor deficit, markedly asymmetrical deficit and generalized areflexia, which are all uncommon in the diabetic neuropathy, in favor of a non-diabetic origin of the neuropathy and should lead to further investigations

Vascular endotheliaf growtli factor [VEGF]: an association with diabetic microvascular complications

The mediators of diabetic microvascular complications remain largely unknown. As diabetic stinopathy is associated with ischaemic changes followed by neovascularization, a role has been proposed for vascular endothelial growth factor [VEGF] its pathogenesis. Subjects and Serum EGF levels were studied in 55 diabetic patients at ferent stages of their disease and microvascular mplications. It was first noted that ciculating VEGF levels were significantly higher in betic patients [421 +/- 309 pg/ml, mean +/- SD] npared to controls [188 +/- 145 pg/ml], P < 0.05. ther analysis showed VEGF levels to be highest in] etic patients with proliferate retinopathy 1 +/- 376 pg/ml]. The level in those with and without background retinopathy was comparable to that of controls [379 +/- 250 pg/ml]. A significant rise in serum VEGF was also detected in patients with significant proteinuria [662 +/- 276 pg/ml]. The level in those with icroalbuminuria was comparable to that of controls [375 +/- 273 pg/ml]. A positive, albeit weak, correlation was noted between serum VEGF and urinary albumin excretion [r= 0.27, P < 0.05]. This study confirms raised circulating level of VEGF in diabetic patients with advanced microvascular disease [proliferate retinopathy and established nephropathy]