No change of hyperleptinemia despite a decrease in insulin concentration in patients with chronic renal failure on a supplemented very low protein diet

Précigout, V. De; Chauveau, Philippe; Delclaux, Caroline; Haggan, Waël El; Baillet, Laurence; Barthe, Nicole; Gobinet, Agnès; Combe, Christian; Aparicio, Michel

doi:10.1053/ajkd.2000.19835

Cited by 12 publications

(10 citation statements)

References 24 publications

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“…Low protein, low phosphorus diets (LPD) are commonly prescribed in conservatively treated patients with CRF in order to retard the rate of renal function decline, although their effect is of a relatively weak magnitude 14 . A LPD has been demonstrated to reduce hyperinsulinaemia and improve insulin resistance, 15–17 as well as hypothalamopituitary‐thyroid axis activity 18,19 . Little is known, however, about the effects of LPD on circulating leptin and TNF‐alpha levels.…”

Section: Introductionmentioning

confidence: 99%

Low protein diet causes a decrease in serum concentrations of leptin and tumour necrosis factor‐alpha in patients with conservatively treated chronic renal failure

Kozłowska¹,

Rosołowska-Huszcz²,

Rydzewski

2004

Nephrology

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Section: Introductionmentioning

confidence: 99%

Low protein diet causes a decrease in serum concentrations of leptin and tumour necrosis factor‐alpha in patients with conservatively treated chronic renal failure

Kozłowska¹,

Rosołowska-Huszcz²,

Rydzewski

2004

Nephrology

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“…Although increased leptin production might be expected from the hyperinsulinemia accompanied by insulin resistance and increased proinflammatory cytokine levels, the leptin level was relatively low in our patient, which might reflect her lean body composition. de Précigout et al 35 showed no change of hyperleptinemia, despite a decrease in insulin concentration, in patients with ESRD on a supplemented very-low-protein diet. Thus, the leptin level is not necessarily in proportion to the insulin level.…”

Section: Discussionmentioning

confidence: 97%

The beneficial effect of effective control of anemia on hyperinsulinemia and hypoxemia in a hemodialysis patient with corrected transposition of the great arteries

et al. 2004

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We report the beneficial effect of control of anemia on hyperinsulinemia and hypoxemia in a hemodialysis patient with corrected transposition of the great arteries. The patient's hemoglobin (Hb) level of 10.3 g/dl on admission represents good control for hemodialysis (HD) patients, but it was too low for this patient with secondary polycythemia because of a right-to-left shunt. Control of anemia for a 10-month period was followed by a marked increase in Hb level (from 10.3 g/dl to 13.9 g/dl) and in aerobic work capacity, while the fasted insulin level decreased from 36.7 microU/ml to 8.0 microU/ml, without changes in leptin level, body mass index (BMI), fat mass, Kt/V, or protein catabolic rate (PCR). Additionally, hypoxemia was ameliorated, from PO2 33.1 mmHg to PO2 56.2 mmHg, and the hyperdynamic cardiac state was improved. The degree of anemia, together with deteriorating tissue oxygenation, may have predisposed this patient to developing insulin resistance and consequent hyperinsulinemia. The most appropriate target Hb concentration should be tailored for the clinical condition of each individual patient, bearing in mind an insulin-resistance state, especially in hemodialysis patients with hypoxemia. A more complete understanding of what regulates insulin resistance and consequent hyperinsulinemia in endstage renal disease (ESRD) awaits the elucidation of carbohydrate and insulin metabolism.

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“…TNFa is increased in uraemic patients [45,46], but this seems to reflect an activation of the TNF-a system only in patients on haemodialysis [47], which is known to reduce insulin resistance. The high leptin levels in CRF are correlated with insulin levels [48,49], but they persist despite improved insulin sensitivity in CRF patients treated by a very low protein diet [50]. Resistin inhibits the action of insulin [51], and high levels of resistin have been found in patients with IgA nephropathies and low GFR, although they were not associated with additional insulin resistance in these patients [52].…”

Section: Why Are Uraemic Patients Insulin Resistant?mentioning

confidence: 99%

Carbohydrate metabolism in uraemia

Rigalleau

Gin

2005

Current Opinion in Clinical Nutrition and Metabolic Care

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The treatment of uraemia by renal replacement therapies or low-protein diets improves insulin sensitivity. However, patients still have a high cardiovascular risk. The identification of the accumulating molecular species that specifically alter insulin sensitivity is therefore of great interest. The favourable effect of non-specific insulin sensitizers such as glitazone may also help to reduce this risk.

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No change of hyperleptinemia despite a decrease in insulin concentration in patients with chronic renal failure on a supplemented very low protein diet

Cited by 12 publications

References 24 publications

Low protein diet causes a decrease in serum concentrations of leptin and tumour necrosis factor‐alpha in patients with conservatively treated chronic renal failure

Low protein diet causes a decrease in serum concentrations of leptin and tumour necrosis factor‐alpha in patients with conservatively treated chronic renal failure

The beneficial effect of effective control of anemia on hyperinsulinemia and hypoxemia in a hemodialysis patient with corrected transposition of the great arteries

Carbohydrate metabolism in uraemia

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