Review Article

Metabolic Syndrome and Renal Injury

Table 3

The Adipokines effect on insulin sensitivity.

Adipokines (Adipose-derived protein)Effect on insulin sensitivity [73]Clinical significance in CKD [4, 74]

ResistinDeclineElevated serum levels
Similar levels in both HD and PD
Associated to heart disease in dialysis [4]

TNF-αDeclineElevated serum level
Enhance gene expression of TNF-α in circulating blood cells in uraemia
Elevated TNF-α associated to increased mortality in HD
Anorexia and a poor nutritional status in PD [4]

IL-6DeclineElevated serum levels
Reliable predictor of mortality
Better mortality predictor than TNF-α in CKD and HD [4]

PAI-1DeclineElevated serum level
Plasma PAI-1 levels increase in several chronic inflammatory states that are associated with CKD
It may contribute to the pathogenesis of the accelerated vascular disease in this patient population [74]

LeptinImprovementMarkedly elevated serum level
Clinical marker of body fat content in dialysis
Associated to inflammation, atherogenic lipid profile, and insulin resistance in CKD
Low leptin is an independent risk factor for mortality in HD [4]

AdiponectinImprovementElevated serum level
Inversely associated with metabolic risk factors in uremia
Inversely associated with CV events in HD
Improved survival and better outcome in dialysis patients [4]

VisfatinImprovementElevated serum level
Anorexigenic
Decreased circulating levels of amino acids and triacylglycerols
Mortality predictor in CKD [4]

IL-6: interleukin-6, PAI-1: plasminogen activator inhibitor-1, TNF-α: tumor necrosis factor-alpha, HD: hemodialysis, PD: peritoneal dialysis.