title: 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.
authors.affiliation: Department of Internal Medicine, College of Medicine, Brain Korea 21 for Medical Science, Severance Biomedical Science Institute, Yonsei University, Seoul, Korea.
authors.forename: Jung Tak
authors.initials: JT
authors.lastname: Park
authors.forename: Tae-Hyun
authors.initials: TH
authors.lastname: Yoo
authors.forename: Jwa-Kyung
authors.initials: JK
authors.lastname: Kim
authors.forename: Hyung Jung
authors.initials: HJ
authors.lastname: Oh
authors.forename: Seung Jun
authors.initials: SJ
authors.lastname: Kim
authors.forename: Dong Eun
authors.initials: DE
authors.lastname: Yoo
authors.forename: Mi Jung
authors.initials: MJ
authors.lastname: Lee
authors.forename: Dong Ho
authors.initials: DH
authors.lastname: Shin
authors.forename: Seung Hyeok
authors.initials: SH
authors.lastname: Han
authors.forename: Dae-Suk
authors.initials: DS
authors.lastname: Han
authors.forename: Shin-Wook
authors.initials: SW
authors.lastname: Kang
mesh_terms: D052242:Adiponectin / Q000097:blood*; D050197:Atherosclerosis / Q000097:blood* / Q000150:complications / Q000401:mortality; D015415:Biomarkers / Q000097:blood; D003920:Diabetes Mellitus; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood / Q000150:complications / Q000628:therapy*; D020738:Leptin / Q000097:blood*; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000401:mortality*; D011379:Prognosis; D011446:Prospective Studies; D056910:Republic of Korea / Q000453:epidemiology; D015996:Survival Rate / Q000639:trends; D013997:Time Factors
chemical_list: D052242:Adiponectin; D015415:Biomarkers; D020738:Leptin