title: Proteinuria and its relation to diverse biomarkers and body mass index in chronic hemodialysis.
abstract: BACKGROUND
  Certain adipokines exert direct effects on proteinuria, a cardiovascular risk factor ignored in hemodialysis. We measured different adipokines according to body mass index (BMI) in relation to proteinuria.
  
  
  METHODS
  Patients numbered 57: group A (GA), BMI<25, n = 22; GB, BMI 25-30, n = 15; and GC, BMI > 30, n = 20. There were no statistical differences in age, sex, time on dialysis, cause of renal failure, diabetes, hypertension, C-reactive protein, or nutritional status. Measures were taken of 24-hour diuresis and proteinuria, ultrafltration, albumin, pro-brain natriuretic peptide (Pro-BNP), insulin, adiponectin, leptin, and ghrelin.
  
  
  RESULTS
  Proteinuria was signifcantly higher in GC versus (vs) GA (1.5 g/day, range 0.30-14 vs 0.72 g/day, range 0.1-2.7; P < 0.01) and correlated signifcantly with leptin levels (ρ = 0.47, P < 0.05). In GA, elevated levels of Pro-BNP, adiponectin, and ghrelin were associated with lower degrees of proteinuria. Signifcant correlations were found between adiponectin and leptin (ρ = -0.54, P = 0.03), and adiponectin and Pro-BNP (ρ = 0.59, P = 0.02). Though not signifcant, there were more diabetics in GC (GA four, GB three, GC ten). As BMI increased in GB and GC, Pro-BNP, adiponectin, and ghrelin levels decreased signifcantly, while proteinuria, insulin, and homeostasis model assessment of insulin resistance increased. Leptin levels were signifcantly elevated in GC vs GA and GB. In GC, ghrelin correlated signifcantly with Pro-BNP (ρ = 0.51, P = 0.03), while leptin correlation with Pro-BNP was inverse and signifcant in GA (ρ = -0.74, P < 0.001) and inverse and nonsignifcant in GB and GC.
  
  
  CONCLUSIONS
  In patients with BMI < 25, higher adiponectin, ghrelin, and Pro-BNP levels were associated with lower proteinuria and leptinemia. In obesity, hyperleptinemia and hyperinsulinemia associated with higher proteinuria; whether decreased adiponectin-ghrelin-ProBNP and/or elevated leptin-insulin levels aggravate proteinuria remains to be determined.
authors.affiliation: Department of Nephrology.
authors.forename: Hernán
authors.initials: H
authors.lastname: Trimarchi
authors.forename: Alexis
authors.initials: A
authors.lastname: Muryan
authors.forename: María-Soledad
authors.initials: MS
authors.lastname: Raña
authors.forename: Pedro
authors.initials: P
authors.lastname: Paggi
authors.forename: Fernando
authors.initials: F
authors.lastname: Lombi
authors.forename: Mariano
authors.initials: M
authors.lastname: Forrester
authors.forename: Vanesa
authors.initials: V
authors.lastname: Pomeranz
authors.forename: Alejandra
authors.initials: A
authors.lastname: Karl
authors.forename: Mirta
authors.initials: M
authors.lastname: Alonso
authors.forename: Pablo
authors.initials: P
authors.lastname: Young
authors.forename: Mariana
authors.initials: M
authors.lastname: Dicugno
keywords: BMI; Pro-BNP; adiponectin; ghrelin; hemodialysis; leptin; proteinuria