Adiponectin and Cardiovascular Remodeling in End-Stage Renal Disease and Co-Morbid Diabetes Mellitus

Abstract

Objectives and Methods: Altered plasma high-sensitivity C-reactive protein (hs-CRP) and adiponectin (ADP) may contribute to increased vascular inflammation and accelerated atherosclerosis in patients with end-stage renal disease (ESRD) and co-morbid diabetes. Common carotid artery intima-media thickness (CCA-IMT) and atherosclerotic plaque occurrence, left-ventricular mass index (LVMI), and pulse wave velocity of the proximal aorta (PWVr) were determined by ultrasound imaging in 120 ESRD (55 diabetic) patients, and 83 age-, sex-, and blood pressure-matched controls. Also, plasma levels of ADP and hs-CRP were determined and their relationships with the above cardiovascular alterations were analyzed. Results: LVMI, PWVr, CCA-IMT and atherosclerotic plaque occurrence were all increased in ESRD patients compared to controls (all p < 0.001). LVMI (p < 0.05), PWVr (p < 0.001), CCA-IMT (p < 0.001) and atherosclerotic plaque occurrence (p < 0.001) were increased in diabetic compared to nondiabetic ESRD patients. Hs-CRP levels were increased and ADP levels were decreased in diabetic compared to nondiabetic ESRD patients (both p < 0.001). ADP levels correlated inversely with hs-CRP (r = –0.473, p < 0.0001) in ESRD patients. Hs-CRP was positively correlated with LVMI (r = 0.365, p < 0.0001), PWVr (r = 0.42, p < 0.0001) and CCA-IMT (r = 0.18, p = 0.047) while ADP inversely correlated with PWVr (r = –0.263, p = 0.0035) and CCA-IMT (r = –0.207, p = 0.022) in ESRD patients. Conclusion: The present results indicate diabetic disease-specific alterations in the biochemical parameters of hs-CRP and ADP in ESRD patients. The above biochemical parameters were intimately linked to the cardiovascular measurements of LVMI, PWVr and CCA-IMT in patients with ESRD and co-morbid diabetes mellitus.

Androgen Deficiency and Endothelial Dysfunction in Men with End-Stage Kidney Disease Receiving Maintenance Hemodialysis

“…The present CCA-IMT, FMD and NMD of the brachial artery measurements in patients with ESKD were in accordance with the results reported in previous studies [17,18,19,20,21,22]. In this study, ESKD patients with androgen deficiency had increased LVMI, CCAD, CCA-IMT and atherosclerotic plaque occurrence compared with patients without androgen deficiency.…”

“…Whether lower androgenicity might be related to measures of endothelial dysfunction in ESKD patients has not been extensively studied. We have previously reported a relationship between altered levels of adiponectin and high-sensitivity C-reactive protein with measures of arterial elasticity in patients with ESKD [22]. …”

PROGRESS IN UREMIC TOXIN RESEARCH: Adiponectin in Patients with Chronic Kidney Disease

“…Similarly, plasma adiponectin concentration in peritoneal dialysis patients with carotid artery plaques was lower than in those without (32). Moreover, in the general population (33), as well as in hemodialysed patients, an inverse relationship was found between plasma adiponectin concentrations and intima‐media thickness of the common carotid artery, an early marker of atherosclerotic changes (34). Even in interlobular kidney arteries the presence and complexity of arteriosclerotic lesions was negatively related to plasma adiponectin concentration as demonstrated by Iwasa et al.…”

Prognostic Utility of Impedance Cardiography Measurements in Elderly Hemodialysis Patients with Coronary Artery Disease

“…Clinical stability was defined as: (1) the absence of clinically significant changes in symptoms or physical signs determined by examination by the attending physician, and (2) no changes in medical therapy during the study period. Blood pressure was controlled by antihypertensive treatment and by adjustment of ‘dry weight’, the body weight below which a normal albuminemic patient experiences hypotension or muscle cramps, with clinically evident postural hypotension [17]. All patients were dialyzed via an arteriovenous fistula, using the same standardized technique, including synthetic membrane hemodialyzers matched for a patient’s body surface area, bicarbonate dialysate and controlled ultrafiltration rate [17].…”

“…Blood pressure was controlled by antihypertensive treatment and by adjustment of ‘dry weight’, the body weight below which a normal albuminemic patient experiences hypotension or muscle cramps, with clinically evident postural hypotension [17]. All patients were dialyzed via an arteriovenous fistula, using the same standardized technique, including synthetic membrane hemodialyzers matched for a patient’s body surface area, bicarbonate dialysate and controlled ultrafiltration rate [17]. The duration of dialysis sessions was tailored (4 h, 3 times weekly) to achieve a total dialysis dose (Kt/V) >1.2 (1.36 ± 0.19).…”