Diabetes Care
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Diabetes Care 31:e24 2008
DOI: 10.2337/dc07-2410
© 2008 by the American Diabetes Association
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Online Letters: Comments and Responses

Serum Levels of Adipokine Retinol-Binding Protein-4 in Relation to Renal Function

Response to Papavasileiou et al.

Michaela Ziegelmeier, MS1, Anette Bachmann, MD1, Jeannette Seeger, MS1, Ulrike Lossner, BS1, Matthias Blüher, MD2, Michael Stumvoll, MD2 and Mathias Fasshauer, MD2

1 University of Leipzig, Department of Internal Medicine, Leipzig, Germany
2 Interdisciplinary Center for Clinical Research (IZKF), Leipzig, Germany

Address correspondence to Mathias Fasshauer, Ph.-Rosenthal-Str.27, 04103 Leipzig, Germany. E-mail: mathias.fasshauer{at}medizin.uni-leipzig.de

We thank Papavasileiou et al. (1) for their comments concerning our recent findings on circulating retinol-binding protein (RBP)-4 in relation to renal function. The authors describe findings similar to those in our study: upregulation of circulating RBP-4 in hemodialysis patients and a significant correlation between RBP-4 and serum creatinine in univariate analysis.

In addition, they convincingly show that like creatinine, surrogates of nutrition such as lean body mass and protein catabolic rate independently predict RBP-4 serum concentrations in multivariate analysis. Moreover, they present a multivariate model in which Kt/Vurea independently predicts circulating RBP-4. In the Kt/Vurea model, the association with creatinine is lost (P = 0.086); however, the relatively small number of hemodialysis patients (n = 36) might be responsible for this effect. In our opinion, these interesting findings suggest that treatment inadequacy and protein malnutrition might, along with renal impairment, contribute to increased RBP-4 concentrations in hemodialysis patients. Interestingly, another adipocyte-secreted cofactor, leptin, has also been associated with hemodialysis-induced malnutrition (2).

Unfortunately, no data are presented in the letter by Papavasileiou et al. concerning the association between circulating RBP-4 and markers of renal function and nutrition in healthy control subjects. We have recently shown that RBP-4 also correlates with serum creatinine in univariate and multivariate analyses in patients with a glomerular filtration rate >50 ml/min (3), further supporting the notion that renal excretion is a primary pathway for RBP-4 clearance. In future studies, it will be interesting to determine whether circulating RBP-4 is also associated with nutritional status in patients with normal renal function.

References

  1. Papavasileiou V, Liakopoulos V, Sakkas GK, Hadjigeorgiou GM, Koukoulis G, Stefanidis I: Serum levels of adipokine retinol-binding protein-4 in relation to renal function. Diabetes Care 31:e23, 2008. DOI: 10.2337/dc07-2257[Free Full Text]
  2. Young GA, Woodrow G, Kendall S, Oldroyd B, Turney JH, Brownjohn AM, Smith MA: Increased plasma leptin/fat ratio in patients with chronic renal failure: a cause of malnutrition? Nephrol Dial Transplant 12:2318–2323, 1997[Abstract/Free Full Text]
  3. Ziegelmeier M, Bachmann A, Seeger J, Lossner U, Kratzsch J, Bluher M, Stumvoll M, Fasshauer M: Serum levels of the adipokine RBP-4 in relation to renal function. Diabetes Care 30:2588–2592, 2007[Abstract/Free Full Text]

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