THE 24-MONTH CHANGES IN BODY FAT MASS AND ADIPOKINES IN PATIENTS STARTING PERITONEAL DIALYSIS

초록

Background: Peritoneal dialysis (PD) is characterized by a gain in fat mass. The fat tissue is a complex endocrine organ that releases various adipokines. In this study, we prospectively examined serial changes of fat composition and adipokines in patients undergoing PD. Methods: Body composition was assessed by computed tomography (CT). Nutrition status and adipokines (leptin, adiponectin, interleukin [IL]-6, and tumor necrosis factor [TNF]-alpha) were assessed on the 7th day and 6 months, 12 months, and 24 months after the start of PD. Results: Fifty-four patients (28 men), with a mean age of 53.2 +/- 13.2 years, were enrolled. Baseline fat mass, especially subcutaneous fat mass, was correlated with baseline leptin (rho = 0.612), adiponetin (rho = -0.477), and interleukin-6 (IL-6) (rho = 0.391). Visceral fat mass was correlated with leptin (rho = 0.545) and adiponectin (rho = -0.514). Baseline adiponectin was negatively correlated with baseline leptin (rho = -0.363). While body weight and leptin increased during the 24 months, serum adiponectin decreased in that period. The changes in visceral and subcutaneous fat mass were greater in the first 12 months and 6 months, respectively. There was no difference in IL-6 and TNF-alpha. Eight patients died during the follow-up period (mean 47.4 months). Twenty-seven patients continued PD. Increased baseline and serial change of IL-6 level were risk factors for mortality. After adjusting for age, sex, diabetes mellitus (DM), and coronary vascular disease (CVD), the significance of the IL-6 level disappeared. Conclusions: Baseline subcutaneous fat in patients starting PD is correlated with baseline adipokine levels rather than visceral fat. The increase in subcutaneous fat was greatest in the first 6months. While leptin and adiponectin increased and decreased respectively, IL-6 did not change in the first 24 months.

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