Effects of diet and exercise on adipocytokine levels in patients with moderate to severe chronic kidney disease

Nutr Metab Cardiovasc Dis. 2020 Jul 24;30(8):1375-1381. doi: 10.1016/j.numecd.2020.04.012. Epub 2020 Apr 21.


Background and aims: Obesity is a pro-inflammatory risk factor for progression of CKD and cardiovascular disease. We hypothesized that implementation of caloric restriction and endurance exercise would improve adipocytokine profiles in patients with moderate to severe CKD.

Methods and results: We enrolled patients with moderate to severe CKD through a multi-center pilot randomized trial of diet and exercise in a 4-arm design (dietary restriction of 10%-15% reduction in caloric intake, exercise three times/week, combined diet and exercise, and control) (NCT01150851). Adipocytokines (adiponectin and leptin) were measured at the beginning and end of the study period as secondary outcomes. Treatment effect was analyzed in a multivariable model adjusted for baseline outcome values, age, gender, site and diabetes. A total of 122 participants were consented, 111 were randomized (42% female, 25% diabetic, and 91% hypertensive), 104 started intervention and 92 completed the study (Figure 1). Plasma adiponectin levels increased significantly in response to diet by 23% (95% CI: 0.2%, 49.8%, p = 0.048) among participants randomized to the caloric restriction and usual activity arm but not to exercise, whereas circulating leptin did not change by either treatment.

Conclusion: Our data suggest that dietary caloric restriction increases plasma adiponectin levels in stage 3-4 CKD patients, with limited effect on leptin levels. These findings suggest the potential for improving the metabolic milieu of CKD with moderate calorie restriction.

Keywords: Adiponectin; Chronic kidney disease; Diet; Exercise; Leptin.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adipokines / blood*
  • Adiponectin / blood
  • Adult
  • Aged
  • Biomarkers / blood
  • Caloric Restriction*
  • Exercise Therapy*
  • Female
  • Humans
  • Leptin / blood
  • Male
  • Middle Aged
  • Physical Endurance
  • Pilot Projects
  • Renal Insufficiency, Chronic / blood
  • Renal Insufficiency, Chronic / diagnosis
  • Renal Insufficiency, Chronic / therapy*
  • Severity of Illness Index
  • Time Factors
  • Treatment Outcome
  • United States


  • ADIPOQ protein, human
  • Adipokines
  • Adiponectin
  • Biomarkers
  • LEP protein, human
  • Leptin

Associated data

  • ClinicalTrials.gov/NCT01150851