Adipokines as predictive factor of cardiac function in pediatric patients with chronic kidney disease.Background
 Adipokines are associated with cardiovascular disease; in chronic kidney disease (CKD) patients adipokines could be useful prognostic factors.


 Objectives
 To explore whether leptin and adiponectin in kidney replacement therapy (KRT) children could have a role on their cardiac function, in the long-term.


 Prospective cohort study was performed with pediatric KRT patients, aged 8 to 17 years who were undergoing hemodialysis or peritoneal dialysis.  At enrollment, lipid profile, adipokines (leptin, leptin receptor, free leptin, and adiponectin), anthropometric measurements and cardiological evaluation were determined.  At two-year follow-up, a new cardiological evaluation was performed.  Statistical analysis: Quantitative data are presented as median and interquartile range (IQR).  Mann-Whitney U test and Chi-squared were used for the between-group comparison.  Multivariate analyzes were performed to determine the association of adipokines levels with ventricular ejection fraction (LEVF).


 We included 56 patients, with a median age of 12.5 years.  In the first cardiological evaluation, median LVEF was 70.0% (IQR 61%, 76%), 20 patients (35.7%) had some cardiovascular condition, and 10 (17.8%) altered LVEF.  Delta-LVEF were correlated with baseline adipokines serum levels, and the only positive correlation found was with free leptin (r=0.303, p=0.025).  In multivariate analysis, levels of free leptin (Coef. 0.12, p<0.036) and leptin (coef. 1.72, p=0.049), as well as baseline LVEF (Coef. -0.65, p<0.001) were associated with delta-LVEF.


 Conclusions
 Free leptin, leptin and LVEF at the beginning of follow-up were associated with the LVEF decrease at the 24-month follow-up in KRT children.
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