Usefulness of the conicity index together with the conjoint use of adipocytokines and nutritional-inflammatory markers in hemodialysis patients

Abstract

Abdominal fat has been recognized as the most hormonally active tissue secreting a variety of adipocytokines and, therefore, potentially contributing to inflammation. The conicity index (C_index) has been considered a valuable indicator of central obesity. This study aims to relate plasma concentrations of leptin, adiponectin, interleukin-6 (IL-6), and serum C-reactive protein (CRP) with C_index values in hemodialysis (HD) patients. Cross-sectional study in 45 HD patients (55.6 % men; DM 20 %; mean age, 68.1 year). C_index and nutritional-inflammatory markers were used for the abdominal fat depot assessment. Patients were classified as having a low or high median C_index (MC_index): low group (men, <1.39; women, <1.33) and high group (men, ≥1.39; women, ≥1.33). A combination of plasma leptin, IL-6, adiponectin, and CRP was used to design an inflammatory index (I_index) while a protein-energy wasting index (PEW_index) was calculated from the I_index plus the malnutrition-inflammation score (MIS). Waist circumference (WC) and C_index but not BMI were significantly higher in men than in women (p < 0.01). The MC_index was significantly associated with the adipocytokine profile (CRP, leptin, and adiponectin). Patients with a high MC_index had a higher I_index and PEW_index (p < 0.01). ROC curve analyses measured by area under the curve (AUC) were 0.69 and 0.68 (p < 0.05), for the C_index and MC_index, respectively, demonstrating the usefulness of the C_index as an abdominal fat mass biomarker able for wasting-inflamed HD patients. These findings in HD patients underscore the importance of incorporating the evaluation of one abdominal fat indicator, such as the C_index and an inflammatory biomarker such as the IL-6 and CRP, in substitution of the BMI, in current clinical practice.

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