THE PREDICTIVE ROLE OF LEPTIN IN MALNUTRITION-INFLAMMATION COMPLEX SYNDROME IN HEMODIALYSIS PATIENTS.

Abstract

Leptin is a protein hormone secreted by adipocytes. Its role in malnutrition-inflammation complex syndrome (MICS) in hemodialysis (HD) patients has not been fully resolved yet. We aimed to assess the predictive role of serum leptin in MICS in maintenance HD patients. This prospective study included 93 HD patients who were distributed in three groups according to serum leptin levels (low-normal-high). Nutritional and inflammatory parameters of MICS, as well as malnutrition-inflammation score (MIS), were determined at baseline and after 12 months. In all subjects, the median serum leptin levels were above the relevant reference range at both the baseline (10 ng/mL; interquartile range (IQR) 4.2-29.9 ng/mL) and at the 12-month follow-up (13 ng/mL; IQR 3.5-39.5 ng/mL). Patients with decreased serum leptin levels had elements of MICS present. Leptin exhibited good sensitivity (0.89), while its specificity was similar to that of other nutritional and inflammatory parameters (0.45 for leptin vs. 0.65 for body mass index, 0.46 for MIS, 0.63 for C-reactive protein, 0.44 for albumins, 0.47 for ferritin and 0.50 for transferrin). The ROC curve analysis identified leptin levels of ≤3.4 ng/mL in men and ≤11.4 ng/mL in women to have the best predictive value for MICS. In conclusion, leptin appears to be a reliable marker of MICS.