Adipokines impact on clinical outcomes is not adequately addressed in
peritoneal dialysis (PD). We investigated the impact of
leptin/
adiponectin ratio (L/A) as a predictor of cardiovascular events (CVE) in PD, taking into consideration patient's body composition and the potential role of
glucose load. We prospectively followed 66 prevalent PD patients for 47.0 ± 28.2 months. New CVE were evaluated. Lean tissue index (LTI), relative fat mass (relFM) and relative
overhydration (relOH) using multifrequency bioimpedance (BCM) were assessed; serum
lipids,
interleukin-6 (IL-6),
leptin and
adiponectin were measured. We established the determinants of L/A using multiple linear regression and the impact of L/A on CVE.
Obesity was present in 47 (73.4%) patients according to relFM, and in seven (10.6%) according to body mass index (BMI).
Leptin and L/A exhibited a stronger correlation with relFM (both r = 0.62, P < 0.0001) than with BMI (r = 0.46 and r = 0.51, respectively, both P < 0.0001). L/A showed a significant correlation with
triglycerides (r = 0.41, P = 0.001) and
HDL-cholesterol (r = -0.358, P = 0.003), better than isolated
leptin or
adiponectin. RelFM (RR = 0.130, 95%confidence interval [CI]:0.086-0.174, P < 0.0001) and LTI (RR = 0.194, 95%CI:0.037-0.351, P = 0.016) were independent predictors of L/A (R(2) = 0.67). Patients who suffered new CVE were older (59.12 ± 12.41 vs. 47.52 ± 13.84years, P = 0.003) and had a higher relOH (11.28 ± 7.29 vs. 6.60 ± 8.16%, P = 0.028). L/A was significantly higher in patients with CVE[2.29 (1.79) vs. 0.65 (1.73), P = 0.028] but this association was only put on evidence after excluding patients with wasting. BMI is an inaccurate method to classify
obesity in PD since it underestimates its prevalence compared with body composition assessment using BCM. High
adiponectin and low
leptin are associated with a more favorable metabolic risk profile in
peritoneal dialysis. The L/A is determined by relFM and by LTI. A higher L/A is associated with CVE in PD patients without wasting.