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Beberashvili I, Cohen-Cesla T, Khatib A, Hamad RA, Azar A, Stav K, Efrati S. Comorbidity burden may explain adiponectin's paradox as a marker of increased mortality risk in hemodialysis patients. Sci Rep 2021; 11:9087. [PMID: 33907250 PMCID: PMC8079690 DOI: 10.1038/s41598-021-88558-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 04/05/2021] [Indexed: 01/10/2023] Open
Abstract
Despite experimental evidence of beneficial metabolic, antiatherosclerotic and antiinflammatory effects of the 30 kDa adipokine, adiponectin, maintenance hemodialysis (MHD) patients with high adiponectin blood levels have paradoxically high mortality rates. We aimed to examine the direction of the associations between adiponectin and all-cause and cardiovascular mortality as well as with markers of oxidative stress, inflammation and nutrition in MHD patients with varying degrees of comorbidities. A cohort of 261 MHD patients (mean age 68.6 ± 13.6 years, 38.7% women), grouped according to baseline comorbidity index (CI) and serum adiponectin levels, were followed prospectively for six years. High and low concentrations were established according to median CI and adiponectin levels and cross-classified. Across the four CI-adiponectin categories, the group with low comorbidities and high adiponectin exhibited the best outcomes. Conversely, the high comorbidity group with high adiponectin levels had the lowest survival rate in both all-cause mortality (log rankχ2 = 23.74, p < 0.001) and cardiovascular mortality (log rankχ2 = 34.16, p < 0.001). Further data adjustment for case-mix covariates including fat mass index did not substantially affect these results. In conclusion, the direction of adiponectin’s prognostic associations in MHD patients is inverse in those with few comorbidities and direct in those with many comorbidities.
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Affiliation(s)
- Ilia Beberashvili
- Nephrology Division, Yitzhak Shamir Medical Center, Zerifin, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Zerifin, Israel.
| | - Tamar Cohen-Cesla
- Internal Department D, Yitzhak Shamir Medical Center, Zerifin, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Zerifin, Israel
| | - Amin Khatib
- Nephrology Division, Yitzhak Shamir Medical Center, Zerifin, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Zerifin, Israel
| | - Ramzia Abu Hamad
- Nephrology Division, Yitzhak Shamir Medical Center, Zerifin, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Zerifin, Israel
| | - Ada Azar
- Nutrition Department, Yitzhak Shamir Medical Center, Zerifin, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Zerifin, Israel
| | - Kobi Stav
- Urology Department, Yitzhak Shamir Medical Center, Zerifin, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Zerifin, Israel
| | - Shai Efrati
- Nephrology Division, Yitzhak Shamir Medical Center, Zerifin, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Zerifin, Israel
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Kuo IC, Wu PH, Lin HYH, Niu SW, Huang JC, Hung CC, Chiu YW, Chen HC. The association of adiponectin with metabolic syndrome and clinical outcome in patients with non-diabetic chronic kidney disease. PLoS One 2019; 14:e0220158. [PMID: 31323071 PMCID: PMC6641197 DOI: 10.1371/journal.pone.0220158] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 07/09/2019] [Indexed: 02/07/2023] Open
Abstract
Adiponectin is the most abundant circulating adipokine, and it has insulin-sensitizing and anti-inflammatory properties. Although it has been speculated that kidney function decline associated with elevated adiponectin is attributable to decreased renal clearance and compensatory responses to adiponectin resistance, it is unclear how elevated adiponectin affects clinical outcomes in chronic kidney disease (CKD) patients and whether the effects are the same as those in the general population. Therefore, the aim of this study is to examine whether the association between serum adiponectin levels and clinical outcomes in non-diabetic CKD patients is independent of adiposity and metabolic syndrome. We enrolled 196 non-diabetic CKD patients with eGFR ranging between 10 and 60 mL/min/1.73 m2, these patients were divided into two groups based on the presence of metabolic syndrome. The primary endpoint was all-cause mortality or renal events (renal failure requiring renal replacement therapy [RRT] or 50% reduction in eGFR). During the mean follow-up period of 5 years, 48 (24.5%) incident cases of end-stage renal disease (ESRD) were observed, and 33 (16.8%) deaths occurred. The mean eGFR was 29.8 ± 12.8 mL/min/1.73m2. The baseline median adiponectin concentration in the cohort was 29.4(interquartile range, 13.3-108.7) μg/ml. Adiponectin levels were inversely related to body mass index (BMI) (r = -0.29; P < 0.001) and waist circumference (r = -0.35; P < 0.001). In the fully adjusted Cox regression model, the hazard ratios (HRs) were 2.08 (95% confidence interval [CI], 1.08-4.02; P = 0.03) for RRT and 1.66 (95% CI, 1.03-2.65; P = 0.04) for composite renal outcome. The risks remained consistent within different subgroups. However, no association was observed with mortality risk. In conclusion, higher adiponectin levels are associated with a higher risk of ESRD independent of conventional risk factors, BMI, and metabolic syndrome components.
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Affiliation(s)
- I-Ching Kuo
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ping-Hsun Wu
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hugo You-Hsien Lin
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Sheng-Wen Niu
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jiun-Chi Huang
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chi-Chih Hung
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- * E-mail: (CCH); (YWC)
| | - Yi-Wen Chiu
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- * E-mail: (CCH); (YWC)
| | - Hung-Chun Chen
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
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Menezes AMB, Oliveira PD, Wehrmeister FC, Assunção MCF, Oliveira IO, Tovo-Rodrigues L, Ferreira GD, Gonçalves H. Association of modifiable risk factors and IL-6, CRP, and adiponectin: Findings from the 1993 Birth Cohort, Southern Brazil. PLoS One 2019; 14:e0216202. [PMID: 31071114 PMCID: PMC6508856 DOI: 10.1371/journal.pone.0216202] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Accepted: 04/16/2019] [Indexed: 12/12/2022] Open
Abstract
Background The literature on the relationship between lifestyle behaviors and inflammatory markers is scarce. Methods A birth cohort was followed since birth up to 22 years in Southern Brazil. Interleukin-6 (IL-6), C-reactive protein (CRP) and adiponectin were measured in nonfasting blood samples drawn at 18 and 22 years of age. Exposures including smoking, alcohol intake, physical inactivity and obesity, were collected at 15, 18 and 22 years. Cross sectional analyses were based on the number of follow-up visits with these exposures and the association with IL-6, CRP and adiponectin at 22 years old. We also carried out a longitudinal Generalized Least Squares (GLS) random-effects analysis with outcomes at 18 and at 22 years old. All analyses were adjusted for several covariates. Results The sample comprised 3,479 cohort members at 22 years. The presence of obesity at ≥ 2 follow-ups showed the highest mean values (SE) for IL-6 [2.45 (1.05)] and CRP [3.74 (1.11)] and the lowest mean value for adiponectin [8.60 (0.37)] (adjusted analyses, females) compared with other exposures; the highest mean of IL-6 [1.65 (1.05)] and CRP [1.78 (1.11)] and the lowest mean of adiponectin [9.98 (0.38)] were for the number of follow-ups with ≥2 exposures compared to those with no exposures at any follow-up (adjusted analyses, females). The longitudinal analysis showed an increase in obesity associated with IL-6 and CRP in both sexes and an inverse association with adiponectin in females; smoking (in males) was associated with IL-6 and CRP, harmful alcohol intake was associated with CRP in males, and increased in physical activity was inversely associated with CRP in men. Conclusion We concluded that obesity is the main exposure positively associated with IL-6 and CRP and inversely associated with adiponectin (mainly in females). Smoking is also associated with these markers in the longitudinal analysis (in males).
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Affiliation(s)
| | | | | | | | - Isabel O. Oliveira
- Federal University of Pelotas—Postgraduate Program in Epidemiology, Pelotas, Brazil
| | | | - Gustavo Dias Ferreira
- Federal University of Pelotas—Department of Physiology and Pharmacology, Pelotas, Brazil
| | - Helen Gonçalves
- Federal University of Pelotas—Postgraduate Program in Epidemiology, Pelotas, Brazil
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Scarale MG, Fontana A, Trischitta V, Copetti M, Menzaghi C. Circulating adiponectin levels are paradoxically associated with mortality rate. A systematic review and meta-analysis. J Clin Endocrinol Metab 2018; 104:5150473. [PMID: 30388239 DOI: 10.1210/jc.2018-01501] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 10/29/2018] [Indexed: 02/03/2023]
Abstract
CONTEXT Some studies have surprisingly indicated that serum adiponectin is positively related to mortality rate, thus casting doubts on its role as a therapeutic target for cardiovascular disease. OBJECTIVE To summarize evidence about direction, strength and modulators of this controversial association. DATA SOURCES MEDLINE, Web of Science, CINHAL, Cochrane Library and Scopus from inception through June 2018. STUDY SELECTION English-language prospective studies reporting the association between adiponectin and all-cause or cardiovascular mortality. DATA EXTRACTION Two investigators independently extracted data and assessed study quality using standard criteria following the Preferred Reporting Items for Systematic Reviews and Meta-analyses and The Newcastle-Ottawa Scale, respectively. Pooled hazard ratios (HRs) (95% confidence intervals-CIs) were derived using a fixed or random effects models when appropriated and were expressed for one standard deviation (SD) increment of adiponectin. DATA SYNTHESIS We identified fifty-five (n=61,676 subjects) and twenty-eight (n=43,979 subjects) studies for all-cause and cardiovascular mortality, respectively. Pooled HRs, were 1.24 (1.17-1.31) and 1.28 (1.19-1.37) for all-cause and cardiovascular mortality, respectively. Similar results were obtained also for High Molecular Weight adiponectin. When meta-analyses were restricted to studies reporting data on natriuretic peptides a 43% and 28% reduction on a log scale of these associations were observed after natriuretic peptides adjustment. CONCLUSIONS Our results strongly points to a paradoxical association between high adiponectin levels and increased mortality rate, which is partly modulated by natriuretic peptides.
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Affiliation(s)
- Maria Giovanna Scarale
- Research Unit of Diabetes and Endocrine Diseases
- Unit of Biostatistics, Fondazione IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Italy
| | - Andrea Fontana
- Unit of Biostatistics, Fondazione IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Italy
| | - Vincenzo Trischitta
- Research Unit of Diabetes and Endocrine Diseases
- Department of Experimental Medicine, "Sapienza" University, Rome, Italy
| | - Massimiliano Copetti
- Unit of Biostatistics, Fondazione IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Italy
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Geagea AG, Mallat S, Matar CF, Zerbe R, Filfili E, Francis M, Haidar H, Jurjus A. Adiponectin and Inflammation in Health and Disease: An Update. ACTA ACUST UNITED AC 2018. [DOI: 10.2174/1874220301805010020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Adiponectin, a protein secreted by adipocytes, gained a special medical attention in the past two decades mostly due to its relation to obesity, a major health problem worldwide. Moreover, adiponectin has shown to have a preventive effect on insulin resistance, diabetes and cardiovascular diseases. Lately, obesity has been classified as a chronic inflammatory state, whereby dysregulated adipocytes and high infiltration of macrophages shift toward the production of pro-inflammatory cytokines like TNF-α and IL-6 among others. This status contributes to a decrease in adiponectin levels, thus leading to the emergence of obesity related complications. This review will focus on the hormone adiponectin and its mechanisms of action in relation to insulin resistance, diabetes, cardiovascular effect and atherosclerosis. It will also cover the various therapeutic approaches aiming to increase the levels of this important cytokine, and to highlight the promising role of AdipoRon, an adiponectin receptor agonist, and of diet.
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Menezes AMB, Oliveira PD, Wehrmeister FC, Gonçalves H, Assunção MCF, Tovo-Rodrigues L, Ferreira GD, Oliveira IO. Association between interleukin-6, C-reactive protein and adiponectin with adiposity: Findings from the 1993 pelotas (Brazil) birth cohort at 18 and 22 years. Cytokine 2018; 110:44-51. [PMID: 29704817 PMCID: PMC6109205 DOI: 10.1016/j.cyto.2018.04.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 04/17/2018] [Accepted: 04/17/2018] [Indexed: 11/29/2022]
Abstract
There is a positive association between IL and 6 and CRP with body adiposity. The analysis between adiponectin and adiposity shows an inverse association. These associations are both cross-sectional and prospective and cumulative. Women show higher mean IL-6, CRP and adiponectin when compared with men. The associations were found in a cohort at 18 and 22 years of age and in both sexes.
Background Most of the literature has shown a direct association between adiposity, interleukin-6 (IL-6) and C-reactive protein (CRP), and an inverse association with adiponectin. The aim of this paper was to assess the association of obesity measurements and IL-6, CRP and adiponectin. Methods We performed cross-sectional/longitudinal analysis in the 1993 Birth Cohort in Brazil. Associations between IL-6 (pg/mL), CRP (mg/L) and adiponectin (µg/Ml) with body mass index (BMI), waist circumference (WC), percentage total fat mass (FM) (BODPOD) and trunk FM (DXA) were verified. Four trajectory variables were generated: (a) highest tertile/obesity according to BMI in both follow-ups; (b) highest tertile/obesity only at 18 years; (c) highest tertile/obesity only at 22 years; (d) not in the highest tertile/not obese at both ages. Results We found a direct association for IL-6 and CRP and an inverse association for adiponectin with measures of adiposity. For instance, for females, the highest mean IL-6 and CRP, respectively, was for those who had been in the obese category at 18–22 years (2.49; 3.75), in the highest tertile of WC (2.11; 3.08), in the highest % of FM (1.56; 3.30 l), and in the highest tertile of trunk FM (2.07; 3.26) (p < 0.001 for all these results in the adjusted analysis). Adiponectin showed an inverse association for the above variables, with lower mean values for males than females. Conclusion There was a longitudinal and direct association between adiposity and IL-6 and CRP, and an inverse association with adiponectin at 22 years.
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Affiliation(s)
- Ana Maria Baptista Menezes
- Federal University of Pelotas - Postgraduate Program in Epidemiology, Rua Marechal Deodoro, 1160, 3° andar, Pelotas, RS. Zip code: 96020-220, Brazil.
| | - Paula Duarte Oliveira
- Federal University of Pelotas - Postgraduate Program in Epidemiology, Rua Marechal Deodoro, 1160, 3° andar, Pelotas, RS. Zip code: 96020-220, Brazil.
| | - Fernando César Wehrmeister
- Federal University of Pelotas - Postgraduate Program in Epidemiology, Rua Marechal Deodoro, 1160, 3° andar, Pelotas, RS. Zip code: 96020-220, Brazil.
| | - Helen Gonçalves
- Federal University of Pelotas - Postgraduate Program in Epidemiology, Rua Marechal Deodoro, 1160, 3° andar, Pelotas, RS. Zip code: 96020-220, Brazil.
| | - Maria Cecilia F Assunção
- Federal University of Pelotas - Postgraduate Program in Epidemiology, Rua Marechal Deodoro, 1160, 3° andar, Pelotas, RS. Zip code: 96020-220, Brazil.
| | - Luciana Tovo-Rodrigues
- Federal University of Pelotas - Postgraduate Program in Epidemiology, Rua Marechal Deodoro, 1160, 3° andar, Pelotas, RS. Zip code: 96020-220, Brazil.
| | - Gustavo Dias Ferreira
- Federal University of Pelotas, Department of Physiology and Pharmacology Campus Capão do Leão, s/n. Pelotas, RS. Zip code: 96010-900, Brazil.
| | - Isabel O Oliveira
- Federal University of Pelotas - Postgraduate Program in Epidemiology, Rua Marechal Deodoro, 1160, 3° andar, Pelotas, RS. Zip code: 96020-220, Brazil.
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Sopić M, Joksić J, Spasojević-Kalimanovska V, Bogavac-Stanojević N, Simić-Ogrizović S, Kravljača M, Jelić Ivanović Z. Downregulation of AdipoR1 is Associated with increased Circulating Adiponectin Levels in Serbian Chronic Kidney Disease Patients. J Med Biochem 2016; 35:436-442. [PMID: 28670196 PMCID: PMC5471639 DOI: 10.1515/jomb-2016-0007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 01/19/2016] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Since the rise in plasma adiponectin levels in chronic kidney disease (CKD) patients has not yet been elucidated, we sought to investigate if patients on hemodialysis (HD) have altered expression of adiponectin receptors in peripheral blood mononuclear cells (PBMCs) compared to healthy subjects. METHODS This study included 31 patients with chronic kidney disease on HD and 33 healthy subjects (CG). Circulating adiponectin levels were measured by ELISA while AdipoR1 and AdipoR2 mRNA levels in PBMCs were determined by real-time PCR. RESULTS Plasma adiponectin levels were significantly higher in patients compared to control group (P=0.036). After adjustment for age, BMI and creatinine, this difference became even more significant (P=0.004). In both groups adiponectin correlated with creatinine (CG: r=-0.472, P=0.006; HD: r=-0.375, P=0.038), triglycerides (CG: r=- 0.490, P=0.004; HD: r=-0.488, P=0.005), insulin (CG: r=-0.386, P=0.038; HD: r=-0.506, P=0.012) and high density lipoprotein cholesterol (HDL-C) (CG: r=-0.672, P<0.001; HD: r=-0.584, P=0.001). Significantly lower expression of PBMCs AdipoR1 mRNA was found in patients compared to CG (P=0.034), while AdipoR2 mRNA levels were similarly expressed in PBMCs in both groups. CONCLUSIONS Complex pathological processes in CKD cause downregulation of AdipoR1 which could ultimately influence AdipoR1 protein levels leading to a state of ≫adiponectin resistance≪.
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Affiliation(s)
- Miron Sopić
- Department of Medical Biochemistry, Faculty of Pharmacy, University of Belgrade, Belgrade, Serbia
| | - Jelena Joksić
- Department of Medical Biochemistry, Faculty of Pharmacy, University of Belgrade, Belgrade, Serbia
| | | | | | - Sanja Simić-Ogrizović
- Clinic of Nephrology, Clinical Center of Serbia, Belgrade, Serbia
- School of Medicine, University of Belgrade, Serbia
| | - Milica Kravljača
- Clinic of Nephrology, Clinical Center of Serbia, Belgrade, Serbia
| | - Zorana Jelić Ivanović
- Department of Medical Biochemistry, Faculty of Pharmacy, University of Belgrade, Belgrade, Serbia
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The combined effect of adiponectin and resistin on all-cause mortality in patients with type 2 diabetes: Evidence of synergism with abdominal adiposity. Atherosclerosis 2016; 250:23-9. [DOI: 10.1016/j.atherosclerosis.2016.04.028] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 04/22/2016] [Accepted: 04/26/2016] [Indexed: 02/06/2023]
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Zhou Y, Zhang J, Zhang W, Ni Z. Association of adiponectin with peripheral arterial disease and mortality in nondiabetic hemodialysis patients: Long-term follow-up data of 7 years. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2016; 21:50. [PMID: 27904596 PMCID: PMC5121992 DOI: 10.4103/1735-1995.184000] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Revised: 01/20/2016] [Accepted: 04/14/2016] [Indexed: 01/25/2023]
Abstract
BACKGROUND The relationships between adiponectin and clinical outcomes in hemodialysis (HD) patients remain highly controversial. Meanwhile, the association between adiponectin and the peripheral artery disease (PAD) has not been well studied in HD patients without diabetic mellitus. MATERIALS AND METHODS The ankle-brachial index was measured in HD patients. Adiponectin levels in 105 HD patients were measured by Enzyme-Linked Immunosorbant Assay. RESULTS 105 HD patients were enrolled; 14 (13%) patients had PAD. Using receiver-operating-characteristic (ROC) curve analysis for PAD, adiponectin (area under the curve [AUC] 0.935, 95% confidence interval [CI]: 0.848-0.981, P < 0.001) showed significantly positive predictive value. During follow-up (mean 63 ± 30 months), 34 deaths (32%) occurred. Kaplan-Meier analysis found those patients lower median adiponectin had a significantly poor outcome (P < 0.05), and Cox analysis further confirmed that adiponectin was an independent predictor of overall mortality (hazard ratio [HR], 0.832, 95% CI: 0.696-0.995, P < 0.05). The ROC curve of overall mortality showed that the AUC of adiponectin was 0.719 (95% CI: 0.586-0.813, P < 0.05). In HD patients with PAD, the univariate analysis showed that adiponectin (HR, 0.649, 95% CI: 0.527-0.800, P < 0.001) was also associated with overall mortality. CONCLUSION Decreasing levels of adiponectin were associated with a significant increase in the risk of PAD in HD patients without diabetic mellitus. Furthermore, as the results of our observation period (maximum of 7 years) showed, adiponectin was a predictor of all-cause mortality in HD patients.
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Affiliation(s)
- Yijun Zhou
- Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jiwei Zhang
- Department of Vascular Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Weiming Zhang
- Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Zhaohui Ni
- Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Ortega Moreno L, Lamacchia O, Salvemini L, De Bonis C, De Cosmo S, Cignarelli M, Trischitta V, Menzaghi C. The paradoxical association of adiponectin with mortality rate in patients with type 2 diabetes: evidence of synergism with kidney function. Atherosclerosis 2016; 245:222-7. [DOI: 10.1016/j.atherosclerosis.2015.12.026] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 12/15/2015] [Accepted: 12/19/2015] [Indexed: 01/02/2023]
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Tung CW, Hsu YC, Shih YH, Lin CL. Association of Adiponectin with High-Sensitivity C-Reactive Protein and Clinical Outcomes in Peritoneal Dialysis Patients: A 3.5-Year Follow-Up Study. PLoS One 2015; 10:e0141058. [PMID: 26474473 PMCID: PMC4608701 DOI: 10.1371/journal.pone.0141058] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 09/05/2015] [Indexed: 11/25/2022] Open
Abstract
Introduction Adiponectin (ADPN), one of most abundant fat-derived biologically active substances, plays an important role in anti-atherosclerotic process. There are conflicting results about the impact of ADPN on cardiovascular (CV) outcomes and mortality, particularly in patients undergoing peritoneal dialysis (PD). Moreover, the relationship between ADPN and inflammatory mediators has been seldom explored in this population. Therefore, we examined the relationship between ADPN and longitudinal high-sensitivity C-reactive protein (hs-CRP) changes and investigated whether ADPN or hs-CRP levels could predict CV outcomes and mortality in prevalent PD patients after comprehensive adjustment of possible confounders. Methods In this prospective cohort study, 78 PD patients were enrolled and followed from February 2009 to August 2012. During follow-up, CV events and all-cause mortality were recorded. Results The mean baseline ADPN value was 29.46±18.01 μg/ml and duration of PD treatment was 37.76±36.96 months. In multiple linear regression analysis, plasma ADPN levels positively correlated with high-density lipoprotein and negatively associated with hs-CRP, body mass index, D4/D0 glucose, triglyceride, and duration of PD treatment. After stratified by genders, the inverse association between baseline ADPN and hs-CRP was more significant in the female group. The hs-CRP levels were followed up annually and remained significantly lower in the high ADPN group in the first 2 years. Patients were then stratified into two groups according to the median ADPN value (23.8 μg/ml). The results of Kaplan-Meier survival analysis demonstrated less CV events and better survival in high ADPN group. On multivariate Cox regression analysis, only ADPN level (HR: 0.93, 95% CI: 0.88–0.98, p = 0.02), age and history of CV diseases were independent risk factors for future CV events. Furthermore, hs-CRP (HR: 1.11, 95% CI:1.001–1.22, p = 0.04) was identified as independent predictor of all-cause mortality. Conclusions Serum hs-CRP levels were consistently lower in the high ADPN group during 2-year follow-up. We also demonstrated the importance of ADPN and hs-CRP in predicting CV events and all-cause mortality in PD population during 3.5-year follow-up.
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Affiliation(s)
- Chun-Wu Tung
- Department of Nephrology, Chang Gung Memorial Hospital, Chiayi, Taiwan
- Graduate Institute of Clinical Medical Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Kidney and Diabetic Complications Research Team (KDCRT), Chang Gung Memorial Hospital, Chiayi, Taiwan
- Chronic Kidney Disease Center, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Yung-Chien Hsu
- Department of Nephrology, Chang Gung Memorial Hospital, Chiayi, Taiwan
- Department of Kidney and Diabetic Complications Research Team (KDCRT), Chang Gung Memorial Hospital, Chiayi, Taiwan
- Chronic Kidney Disease Center, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Ya-Hsueh Shih
- Department of Nephrology, Chang Gung Memorial Hospital, Chiayi, Taiwan
- Department of Kidney and Diabetic Complications Research Team (KDCRT), Chang Gung Memorial Hospital, Chiayi, Taiwan
- Chronic Kidney Disease Center, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Chun-Liang Lin
- Department of Nephrology, Chang Gung Memorial Hospital, Chiayi, Taiwan
- Department of Kidney and Diabetic Complications Research Team (KDCRT), Chang Gung Memorial Hospital, Chiayi, Taiwan
- Chronic Kidney Disease Center, Chang Gung Memorial Hospital, Chiayi, Taiwan
- School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan, Republic of China
- * E-mail:
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12
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Han SS, Bae E, Ahn SY, Kim S, Park JH, Shin SJ, Lee SH, Choi BS, Chin HJ, Lim CS, Kim S, Kim DK. Urinary adiponectin and albuminuria in non-diabetic hypertensive patients: an analysis of the ESPECIAL trial. BMC Nephrol 2015; 16:123. [PMID: 26232133 PMCID: PMC4522110 DOI: 10.1186/s12882-015-0124-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 07/28/2015] [Indexed: 12/18/2022] Open
Abstract
Background Although adiponectin levels have been reported to be correlated with albuminuria, this issue remains unresolved in non-diabetic hypertensive subjects, particularly when urinary adiponectin is considered. Methods Urinary adiponectin levels were examined using an enzyme-linked immunosorbent assay in 229 participants. who used olmesartan as a hypertensive agent. Their albuminuria levels were measured for 16 weeks after randomization and initiation of conventional or intensive diet education. Linear or logistic regression models were applied, as appropriate, to explore the relationship with albuminuria itself or its response after the intervention. Results Urinary adiponectin levels were positively related to baseline albuminuria level (r = 0.529). After adjusting for several covariates, the adiponectin level was associated with the albuminuria level (β = 0.446). Among the 159 subjects with baseline macroalbuminuria, the risk of consistent macroalbuminuria (> 300 mg/day) at 16 weeks was higher in the 3rd tertile of adiponectin than in the 1st tertile (odds ratio = 6.9), despite diet education. In contrast, among all subjects, the frequency of the normoalbuminuria achievement (< 30 mg/day) at 16 weeks was higher in the 1st tertile than in the 3rd tertile (odds ratio = 13.0). Conclusions Urinary adiponectin may be a useful biomarker for albuminuria or its response after treatment in non-diabetic hypertensive patients. Electronic supplementary material The online version of this article (doi:10.1186/s12882-015-0124-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Seung Seok Han
- Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehakro, Jongno-gu, Seoul, 110-744, South Korea.
| | - Eunjin Bae
- Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehakro, Jongno-gu, Seoul, 110-744, South Korea.
| | - Shin Young Ahn
- Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehakro, Jongno-gu, Seoul, 110-744, South Korea. .,Department of Internal Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, 463-707, South Korea.
| | - Sejoong Kim
- Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehakro, Jongno-gu, Seoul, 110-744, South Korea. .,Department of Internal Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, 463-707, South Korea.
| | - Jung Hwan Park
- Department of Internal Medicine, Konkuk University School of Medicine, Seoul, 143-729, South Korea.
| | - Sung Joon Shin
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Gyeonggi-do, 410-773, South Korea.
| | - Sang Ho Lee
- Department of Internal Medicine, Kyung Hee University Medical Center, Seoul, 134-727, South Korea.
| | - Bum Soon Choi
- Department of Internal Medicine, Seoul St. Mary's Hospital, Seoul, 137-701, South Korea.
| | - Ho Jun Chin
- Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehakro, Jongno-gu, Seoul, 110-744, South Korea. .,Department of Internal Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, 463-707, South Korea.
| | - Chun Soo Lim
- Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehakro, Jongno-gu, Seoul, 110-744, South Korea. .,Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, 156-707, South Korea.
| | - Suhnggwon Kim
- Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehakro, Jongno-gu, Seoul, 110-744, South Korea.
| | - Dong Ki Kim
- Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehakro, Jongno-gu, Seoul, 110-744, South Korea.
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13
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Kacso IM, Potra AR, Bondor CI, Moldovan D, Rusu C, Patiu IM, Racasan S, Orasan R, Vladutiu D, Spanu C, Rusu A, Nita C, Moldovan R, Ghigolea B, Kacso G. Adiponectin predicts cardiovascular events in diabetes dialysis patients. Clin Biochem 2015; 48:860-5. [PMID: 26006757 DOI: 10.1016/j.clinbiochem.2015.05.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Revised: 05/14/2015] [Accepted: 05/15/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Adiponectin is an insulin-sensitizing, anti-inflammatory adipokine with anti-atherogenic actions in the general population. In dialysis patients it is unclear whether adiponectin conserves its protective value or is, on the contrary, associated to worse prognosis. We assessed the predictive value of adiponectin for atherosclerosis related cardiovascular events in type 2 diabetic dialysis patients. DESIGN AND METHODS Prevalent diabetic dialysis patients from three dialysis units (n=77) were enrolled in a 3years' prospective observational study. Serum adiponectin, clinical and laboratory parameters were determined at baseline; new occurrence of atherosclerosis related events (coronary events, atherosclerosis obliterans, and stroke) was recorded. RESULTS Baseline adiponectin was 17.25(9.53-31.97) μg/mL and significantly correlated to HDL cholesterol (r=0.29, p=0.01), triglycerides (r=-0.40, p=0.0004), ferritin (r=-0.29, p=0.02), transferrin (r=-0.28, p=0.02), and uric acid (r=-0.24, p=0.04). In multivariate analysis association to triglycerides (p=0.001), HDL cholesterol (p=0.01) and ferritin (p=0.04) remained significant. 36 new fatal and non-fatal new cardiovascular events occurred, 29 patient died. Cox proportional regression analysis showed that adiponectin below or above a ROC-derived cut-off of 27.33μg/mL significantly influenced event-free survival: hazard ratio (HR) 2.48, 95% confidence interval (CI) (1.09-5.66), p=0.031 along with fasting glucose HR 1.01, 95%CI(1.00-1.02), p=0.01 and history of cardiovascular events at inclusion HR 3.16, 95%CI(1.36-7.32), p=0.007. In multivariate analysis baseline adiponectin HR 5.02, 95%CI(0.98-25.06), p=0.05 and glycemia HR 1.01, 95%CI(1.00-1.02), p=0.01 influenced event-free survival. Adiponectin also predicted cardiovascular events in patients without cardiovascular disease at inclusion but was not associated to overall mortality. CONCLUSIONS In diabetes dialysis patients low adiponectin favors occurrence of atherosclerosis related cardiovascular events.
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Affiliation(s)
- I M Kacso
- University of Medicine and Pharmacy "Iuliu Hatieganu" Cluj-Napoca, Department of Nephrology, 3-5 Clinicilor street, 400006 Cluj Napoca, Romania
| | - A R Potra
- University of Medicine and Pharmacy "Iuliu Hatieganu" Cluj-Napoca, Department of Nephrology, 3-5 Clinicilor street, 400006 Cluj Napoca, Romania.
| | - C I Bondor
- University of Medicine and Pharmacy "Iuliu Hatieganu" Cluj-Napoca, Department of Informatics and Biostatistics, 6 Pasteur street, 400349 Cluj Napoca, Romania
| | - D Moldovan
- University of Medicine and Pharmacy "Iuliu Hatieganu" Cluj-Napoca, Department of Nephrology, 3-5 Clinicilor street, 400006 Cluj Napoca, Romania
| | - C Rusu
- University of Medicine and Pharmacy "Iuliu Hatieganu" Cluj-Napoca, Department of Nephrology, 3-5 Clinicilor street, 400006 Cluj Napoca, Romania
| | - I M Patiu
- NephroCare Dialysis Center Cluj, Ana Aslan street 40, 400495 Cluj-Napoca, Romania
| | - S Racasan
- NephroCare Dialysis Center Cluj, Ana Aslan street 40, 400495 Cluj-Napoca, Romania
| | - R Orasan
- NephroCare Dialysis Center Cluj, Ana Aslan street 40, 400495 Cluj-Napoca, Romania
| | - D Vladutiu
- University of Medicine and Pharmacy "Iuliu Hatieganu" Cluj-Napoca, Department of Nephrology, 3-5 Clinicilor street, 400006 Cluj Napoca, Romania
| | - C Spanu
- RenaClinic Cluj, Tache Ionescu street 72, 400473 Cluj-Napoca, Romania
| | - A Rusu
- RenaClinic Cluj, Tache Ionescu street 72, 400473 Cluj-Napoca, Romania
| | - C Nita
- RenaClinic Cluj, Tache Ionescu street 72, 400473 Cluj-Napoca, Romania
| | - R Moldovan
- Nefromed Dialysis Center Alba Iulia, 12 Turnatoriei street, 510185 Alba Iulia, Romania
| | - B Ghigolea
- Nefromed Dialysis Center Alba Iulia, 12 Turnatoriei street, 510185 Alba Iulia, Romania
| | - G Kacso
- University of Medicine and Pharmacy "Iuliu Hatieganu" Cluj-Napoca, Department of Oncology, 34-36 Republicii street, 400115 Cluj-Napoca, Romania
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14
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Rhee CM, Nguyen DV, Moradi H, Brunelli SM, Dukkipati R, Jing J, Nakata T, Kovesdy CP, Brent GA, Kalantar-Zadeh K. Association of Adiponectin With Body Composition and Mortality in Hemodialysis Patients. Am J Kidney Dis 2015; 66:313-21. [PMID: 25824125 DOI: 10.1053/j.ajkd.2015.02.325] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Accepted: 02/12/2015] [Indexed: 12/15/2022]
Abstract
BACKGROUND In the general population, circulating adiponectin is associated with a favorable cardiovascular risk profile (eg, lower triglycerides and body fat) and decreased mortality. Hemodialysis (HD) patients have comparatively higher adiponectin concentrations, but prior studies examining the adiponectin-mortality association in this population have not accounted for body composition or shown a consistent relationship. STUDY DESIGN Prospective cohort study. SETTINGS & PARTICIPANTS We examined baseline serum adiponectin concentrations in 501 HD patients across 13 dialysis centers from the prospective MADRAD (Malnutrition, Diet, and Racial Disparities in Chronic Kidney Disease) cohort (entry period, October 2011 to February 2013; follow-up through August 2013). PREDICTOR Serum adiponectin concentration in tertiles (tertiles 1, 2, and 3 defined as ≤16.1, >16.1-<30.1, and ≥30.1-100.0 μg/mL, respectively). Adjustment variables included case-mix and laboratory test results (age, sex, race, ethnicity, vintage, diabetes, serum albumin, total iron-binding capacity, serum creatinine, white blood cell count, phosphate, hemoglobin, and normalized protein catabolic rate), body composition surrogates (subcutaneous, visceral, and total-body fat and lean body mass), and serum lipid levels (cholesterol, high-density lipoprotein cholesterol, and triglycerides). OUTCOMES All-cause mortality using survival (Cox) models incrementally adjusted for case-mix and laboratory test results. RESULTS Among 501 HD patients, 50 deaths were observed during 631.1 person-years of follow-up. In case-mix- and laboratory-adjusted Cox analyses, the highest adiponectin tertile was associated with increased mortality versus the lowest tertile (HR, 3.35; 95% CI, 1.50-7.47). These associations were robust in analyses that additionally accounted for body composition (HR, 3.18; 95% CI, 1.61-8.24) and lipid levels (HR, 3.64; 95% CI, 1.34-7.58). LIMITATIONS Residual confounding cannot be excluded. CONCLUSIONS Higher adiponectin level is associated with a 3-fold higher death risk in HD patients independent of body composition and lipid levels. Future studies are needed to elucidate underlying mechanisms and determine therapeutic targets associated with improved outcomes in HD patients.
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Affiliation(s)
- Connie M Rhee
- Harold Simmons Center of Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, Orange, CA.
| | - Danh V Nguyen
- Division of General Internal Medicine, University of California Irvine, Orange, CA
| | - Hamid Moradi
- Harold Simmons Center of Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, Orange, CA
| | | | | | - Jennie Jing
- Harold Simmons Center of Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, Orange, CA
| | - Tracy Nakata
- Harold Simmons Center of Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, Orange, CA
| | - Csaba P Kovesdy
- University of Tennessee Health Science Center, Memphis, TN; Division of Nephrology, Memphis VA Medical Center, Memphis, TN
| | - Gregory A Brent
- Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, CA
| | - Kamyar Kalantar-Zadeh
- Harold Simmons Center of Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, Orange, CA
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15
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Abstract
Adiponectin is a 30-kDa polypeptide secreted primarily by adipose tissue and plays a key role in kidney disease. In obesity, reduced adiponectin levels are associated with insulin resistance, cardiovascular disease and obesity related kidney disease. The latter includes microalbuminuria, glomerulomegaly, overt proteinuria and focal segmental glomerulosclerosis. Adiponectin levels in type 2 diabetics also negatively correlate with early features of nephropathy. However, in patients with established chronic kidney disease, adiponectin levels are elevated and positively predict progression of disease. The mechanism of action of adiponectin in the kidney appears to be related to AMPK activation and NADPH oxidase. Further studies are needed to elucidate this pathway and investigate the role of potential targets of adiponectin-AMPK-Nox pathway for CKD as obesity-related CKD is increasing worldwide.
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Affiliation(s)
- Natalie Sweiss
- Center for Renal Translational Medicine, Institute of Metabolomic Medicine, Division of Nephrology-Hypertension, Department of Medicine, University of California, San Diego and VA Medical Center La Jolla, 9500 Gilman Drive, MC 0711, La Jolla, CA 92093, USA.
| | - Kumar Sharma
- Center for Renal Translational Medicine, Institute of Metabolomic Medicine, Division of Nephrology-Hypertension, Department of Medicine, University of California, San Diego and VA Medical Center La Jolla, 9500 Gilman Drive, MC 0711, La Jolla, CA 92093, USA.
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