Reduced plasma visfatin in end-stage renal disease is associated with reduced body fat mass and elevated serum insulin

Objectives: The adipocytokine visfatin has insulin-mimetic, anabolic properties and may be related to adiposity. End-stage renal disease (ESRD) is characterized by progressive catabolism. Glucose and insulin possibly regulate plasma visfatin concentrations. Therefore, we investigated circulating visfatin, insulin, glucose and body composition in ESRD.

Methods: 73 subjects (mean age 61.2 years) were assigned to 3 age- and body mass index-matched groups: 31 controls (C), 30 ESRD patients treated by hemodialysis (HD) and 12 ESRD patients treated by hemodialysis and insulin because of diabetes mellitus (HDIDDM). Fasted blood samples were obtained from all subjects, blood samples after hemodialysis from 29 HD patients, urine from 27 controls. Plasma visfatin concentration was measured by enzyme-linked immuno assay.

Results: Fasted visfatin was decreased in HD (23.6±6.1 ng/ml, p<0.001) and HDIDDM (19.2±6.3 ng/ml, p<0.001) vs. C (31.4±7.0 ng/ml) and in HDIDDM vs. HD (p=0.043). Fasted insulin showed inverse correlation (r=–0.35, p=0.002). Visfatin and insulin changed inversely during dialysis (r=-0.27, p=0.059), reduction of visfatin was independently associated with low body fat mass (p<0.001 by multiple regression analysis). Visfatin concentration in urine of C was 13.85±7.86µg/g creatinine.

Conclusions: Visfatin is excreted by the healthy kidney to a large extent. However, loss of renal function is accompanied by reduced plasma visfatin concentrations. In ESRD, inverse correlation of visfatin and insulin concentrations is observed, suggesting an intact regulation. Reduced levels of circulating visfatin in ESRD and further decrease during hemodialysis in subjects with low fat mass may contribute to progressive catabolism.