Inflammation Cytokines and Adipokines in Patients with Diabetes and Obesity with and Without CKD

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Background: Epidemic of diabetes & obesity is fueling increasing cases of CKD worldwide. Mechanisms involved in complex interplay between obesity, diabetes and CKD are poorly studied, though inflammation & shift in adipokine and cytokine production towards pro-inflammatory state have been implicated We in this cross-sectional, case control study looked at HsCRP & important pro-inflammatory (leptin, IL-6, TNF-α) & anti-inflammatory mediators (adiponectin, IL-10) in subjects with obesity alone, obesity with diabetes & obesity with diabetes & CKD & compared it with healthy controls Methods: 60 consenting subjects in each group were studied. Besides detailed history, BMI calculation; serum levels of HsCRP, adipokines (leptin & adiponectin) & cytokines (IL-6, TNF-α & IL-10) were assessed using commercially available ELISA kits Results: Table shows demographic, clinical & study parameters of each group. Patient groups were gender matched but slightly older than controls. Obese subjects in various groups had similar BMI & waist/hip ratio. All obese groups had evidence of pro-inflammatory state as evidenced by higher HsCRP, leptin, IL6 & TNF-α than controls, with obese diabetic patients with CKD showing maximum aberrations. Levels of adiponectin were lower only in patients with obesity with complications of DM & CKD while IL-10 levels were higher in these groups Conclusion: We document higher pro-inflammatory milieu in obese subjects, which worsens progressively with complications of DM & CKD. Though, absolute values of anti-inflammatory mediators are not affected to similar extent but they might be relatively impaired considering overall pro-inflammatory state Demographic clinical & study parameters - Parameter Controls Obese alone Obese with DM Obese with DM & CKD Age (yr) 43.1 ± 7.5 45.5 ± 6.4* 50.4±10.5* 51.3±12.2* Male (%) 61.6 60 53.3 60 BMI 22.7±2.1 31.8±1.4* 31.4±2.1* 30.4±1.8* Waist/Hip ratio 0.8±.1 0.9±0.2* 0.9±0.1* 1.0±0.1* eGFR (ml/min) 108.3±26.4 102.7±20.5 96.6±9.7*^ 40.0±10.2*^# HsCRP (mg/L) 1.1±0.1 2.4±0.4* 3.9±0.2*^$ 8.4±0.1*^# Leptin (ng/ml) 3.7±0.2 58.6±5.2* 62.3±17.2*$ 83.4±12.2*^# Adiponectin (pg/ml) 5.3±0.7 5.5±0.3 3.7±0.9*^ 2.9±0.6*^ IL-6 (pg/ml) 72.4±8.2 83.4±8.4* 174.5±10.3*^$ 392.9±22.2*^# TNF-α (pg/ml) 5.4±1.1 7.8±1.2* 11.3±0.8*^$ 21.6±1.9*^# IL-10 (pg/ml) 101.8±14.2 71.4±11.9* 139.1±16.6*^ 131.1±36.1*^ *p<0.05 vs group 1, ^ p<0.05 vs group 2, # p<0.05 vs group 3, $ p<0.05 vs group 4

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