Leptin and the kidney

The kidneys play a vital role in the metabolism and clearance of leptin. As renal failure ensues, leptin clearance is reduced causing elevated leptin levels. Chronic inflammation is common in chronic kidney disease (CKD), and may also contribute to the development of hyperleptinemia. Type 2 Diabetes Mellitus or glucose intolerance present in up to half of patients with CKD; insulin and growth hormone may contribute to stimulation of leptin production in patients with CKD. The method of dialysis for patients with end-stage renal disease (ESRD) also plays a role in the likelihood and severity of hyperleptinemia, while renal transplantation has been shown to rapidly normalize leptin levels. This chapter examines prevalence and severity of hyperleptinemia in CKD and ESRD, the factors which increase or decrease leptin levels, and metabolic and clinical significance of leptin changes in CKD, ESRD, and renal transplant recipients.