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Published on: July 14, 2023
Parathyroidectomy Increases Heart Rate Variability and Leptin Levels in Patients with Stage 5 Chronic Kidney Disease
Yao Jiang1, Zhixiang Shen, Jingjing Zhang
1Department of Nephrology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, China.
Insights
In chronic kidney disease (CKD) patients, leptin levels did not correlate with heart rate variability (HRV). However, parathyroidectomy in severe secondary hyperparathyroidism (SHPT) patients increased HRV and leptin, suggesting leptin as a potential cardiovascular disease risk target.
Area of Science:
- Nephrology
- Cardiology
- Endocrinology
Background:
- Decreased heart rate variability (HRV) in chronic kidney disease (CKD) indicates autonomic dysfunction and elevated cardiovascular disease (CVD) risk.
- Severe secondary hyperparathyroidism (SHPT), a complication of CKD-mineral and bone disorder (CKD-MBD), is associated with lower HRV, which parathyroidectomy (PTX) can improve.
- Leptin's interaction with autonomic function is known, but its association with HRV in CKD and longitudinal changes post-PTX remains unclear.
Purpose of the Study:
- To investigate the association between serum leptin levels and HRV in advanced CKD patients.
- To examine the longitudinal changes in HRV and leptin levels in SHPT patients following PTX.
Main Methods:
- Cross-sectional study of 141 stage 5 CKD patients.
- Prospective study of 36 severe SHPT patients undergoing PTX.
- HRV measured by Holter; serum leptin measured by ELISA, adjusted for BMI and log-transformed (lnleptin/BMI).
Main Results:
- No significant differences in HRV indices across leptin/BMI quartiles in CKD patients.
- Serum leptin/BMI was an independent predictor of the low frequency/high frequency ratio in CKD.
- HRV indices and lnleptin/BMI levels increased post-PTX in SHPT patients, with greater lnVLF improvement in the lowest leptin/BMI quartile.
Conclusions:
- Circulating leptin levels may represent a novel therapeutic target for reducing CVD risk in advanced CKD-MBD patients.
- Further research is warranted to elucidate the role of leptin in CKD-associated autonomic dysfunction and CVD.
Background:
In chronic kidney disease (CKD) patients, decreased heart rate variability (HRV) reflects impaired cardiac automatic nervous function and high risk of cardiovascular disease (CVD). Lower HRV in patients with severe secondary hyperparathyroidism (SHPT), a clinical manifestation of CKD-mineral and bone disorder (CKD-MBD), could be reversed by parathyroidectomy (PTX). It has been proved that leptin interacts with the autonomic nervous function. However, the associations between leptin and HRV in CKD patients and their longitudinal changes in SHPT patients after PTX are still unknown.
Methods:
This was a cross-sectional study including 141 stage 5 CKD patients, and a prospective study in 36 severe SHPT patients with PTX. HRV was measured by Holter and serum leptin was measured by ELISA. Serum leptin levels were adjusted for body mass index (BMI) and transformed using natural logarithm (lnleptin/BMI).
Results:
With a gradient of lnleptin/BMI across quartiles from Q1 to Q4 in CKD patients, HRV indices showed no differences among quartiles. Patients in Q1 group had higher mean 24 h heart rates, and lower ln(very low frequency) (lnVLF) than other quartiles, although there were no statistically significant difference. In multivariate stepwise regression, serum leptin/BMI was an independent predictor for low frequency/high frequency. HRV indices and lnleptin/BMI levels were increased in severe SHPT patients after PTX. Compared to other quartiles, SHPT patients in Q1 group had larger improvement of lnVLF after PTX.
Conclusion:
Circulating leptin levels may be a novel treatment target to reduce CVD risk in advanced CKD-MBD patients.
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