Hyperleptinemia positively associated with central arterial stiffness in hemodialysis patients

<div><p>Objective</p><p>Leptin plays a role in stimulating vascular inflammation, vascular smooth muscle hypertrophy, and augmenting blood pressure, which contributes to the pathogenesis of atherosclerosis and leads to arterial stiffness. This vascular damage, measured by carotid-femoral pulse wave velocity (cfPWV), is recognized as an independent predictor of cardiovascular mortality in hemodialysis (HD) patients. The aim of this study was to evaluate the relationship between serum leptin and arterial stiffness in HD patients.</p><p>Patients and methods</p><p>In 112 of the 126 HD patients were eligible and their biochemical data were collected for analysis. Serum leptin level was measured using a commercial enzyme-linked immunosorbent assay kit. Carotid-femoral pulse wave velocity was measured by a validated tonometry system (SphygmoCor). Those have cfPWV values above 10 m/s are defined as the high arterial stiffness group.</p><p>Results</p><p>Among the participants, thirty-eight of them who were in the high arterial stiffness group, had a higher prevalence of diabetes mellitus (p = 0.002), age (p = 0.029), body mass index (BMI, p = 0.018), body fat mass (p = 0.001), hemoglobin (p = 0.040), and serum leptin levels (P<0.001). Multivariable logistic regression analysis showed that leptin (odds ratio [OR] 1.09; 95% confidence interval [CI] 1.04–1.14; p <0.001), diabetes (OR 7.17; CI 1.39–37.00; p = 0.019), body fat mass (OR 1.16; CI 1.02–1.33; p = 0.027); and hemoglobin (OR 2.11; CI 1.15–3.87; p = 0.015) were independently associated with arterial stiffness in HD patients.</p><p>Conclusion</p><p>In our study, hyperleptinemia was positively correlated to the high cfPWV and thus was related to high arterial stiffness in HD patients.</p></div

Correlation between serum leptin levels and clinical variables among 112 hemodialysis patients.

<p>Correlation between serum leptin levels and clinical variables among 112 hemodialysis patients.</p

Clinical variables of the 112 hemodialysis patients with high or low arterial stiffness.

<p>Clinical variables of the 112 hemodialysis patients with high or low arterial stiffness.</p

Distribution of hemodialysis patients with high or low arterial stiffness in subgroup analysis.

<p>Distribution of hemodialysis patients with high or low arterial stiffness in subgroup analysis.</p

Clinical characteristics and serum leptin levels of 112 hemodialysis patients.

<p>Clinical characteristics and serum leptin levels of 112 hemodialysis patients.</p

Study design.

<p>Study design.</p

Increased Risks of Mortality and Atherosclerotic Complications in Incident Hemodialysis Patients Subsequently with Bone Fractures: A Nationwide Case-Matched Cohort Study

<div><p>Background</p><p>Hemodialysis (HD) patients with bone fractures have an increased risk for death. However, the risks for mortality and atherosclerotic complications in incident HD patients subsequently with bone fractures are unknown.</p><p>Methods</p><p>Data derived from the Taiwan National Health Institute Research Database between January 1997 and December 2008 was analyzed. The enrolled patients included 3,008 incident HD patients subsequently with a single long bone fracture (LB Fx) and 2,070 incident HD patients subsequently with a single non-long bone fracture (NLB Fx). These patients were matched (1:5 ratio) for age, sex, and same duration of HD with incident HD patients who had no fractures and outcomes were measured over a 3-year follow-up.</p><p>Results</p><p>After demographic and co-morbidity adjustment, LB Fx increased the risk for overall mortality (HR = 1.59, <i>p</i> < 0.001) and stroke (HR = 1.09, <i>p</i> = 0.028) in incident HD patients. NLB Fx increased the risk for overall mortality (HR = 1.52, <i>p</i> < 0.001), stroke (HR = 1.19, <i>p</i> < 0.001), coronary artery disease (CAD), (HR = 1.13, <i>p</i> = 0.003), and peripheral arterial occlusive disease (PAOD), (HR = 1.41, <i>p</i> < 0.001) in incident HD patients. Moreover, incident patients subsequently with NLB Fx had significantly higher risks of CAD and PAOD than those subsequently with LB Fx.</p><p>Conclusions</p><p>The rates of mortality and stroke were significantly higher in incident HD patients subsequently with bone fractures than in matched patients without bone fractures. Incident HD patients subsequently with NLB Fx had significantly higher risks of CAD and PAOD than those subsequently with LB Fx and without bone fractures. Thus, incident HD patients subsequently with bone fractures should be closely followed for a higher mortality and possible development of atherosclerotic complications.</p></div

Flowchart of enrolled incident hemodialysis patients.

<p>Flowchart of enrolled incident hemodialysis patients.</p

Survival probability and freedom from atherosclerotic complications in incident hemodialysis patients subsequently with long bone fracture (LB Fx), non-long bone fracture (NLB Fx), and without fracture (No Fx) based on the Cox regression model.

<p>(A) Survival. (B) Stroke. (C) Coronary artery disease (CAD). (D) Acute coronary syndrome (ACS). (E) Peripheral arterial occlusive disease (PAOD).</p