Am J Hypertens 2019 Jun 29. Epub 2019 Jun 29.
Service of Nephrology and Hypertension, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland.
Background: Renal sodium handling could be a potential mediator linking adipokines to hypertension. The aim of the study was to assess the relationship of leptin with urinary sodium excretion and proximal sodium reabsorption in humans.
Methods: This crossectional study was conducted on participants of hypertensive families from the Seychelles Island. A split urine (daytime and nighttime) collection and plasma leptin were measured. Endogenous lithium clearance was used to assess proximal sodium reabsorption. Mixed multiple linear regression tests adjusted for confounding factors were used.
Results: 365 participants (57% women) were included in this analysis. Leptin and adiponectin were higher in women (p<0.001). Leptin was associated positively with daytime (coefficient (c): 0.16, standard deviation (sd): 0.03, p<0.001), nighttime urinary sodium excretion (c: 017, sd: 0.04), p<0.019), daytime lithium clearance (c: 0.40, sd: 0.08, p<0.001) and nighttime lithium clearance (c: 0.39, sd: 0.10, p<0.001) after adjusting for sex. The association was lost or mitigated only when BMI was introduced in the model. When BMI was categorized in normal vs overweight participant, leptin was associated with daytime and nighttime sodium excretion rates (c: 0.14, sd: 0.05, p=0.011 and c: 0.22, sd: 0.07, p=0.002 respectively) only in overweight participants.
Conclusion: Leptin is associated positively with daytime and nighttime sodium excretion and lithium clearance suggesting a natriuretic rather than a sodium retaining effect of leptin. Sex and BMI are major confounders in this association. These results highlight the importance of sex and obesity in our understanding of the relationships between leptin, blood pressure and renal sodium handling.