Adiponectin and Mortality in Patients with Chronic Kidney Disease

Abstract

Adiponectin is presumed to possess antiatherogenic and cardioprotective properties. Limited data exist on the relationship between adiponectin and mortality in the earlier stages of chronic kidney disease. The Modification of Diet in Renal Disease study was a randomized, controlled trial that was conducted between 1989 and 1993. Adiponectin was measured in frozen samples that were obtained at baseline (N ‫؍‬ 820). Survival status and cause of death, up to December 31, 2000, were obtained from the National Death Index. Multivariable Cox models were used to examine the relationship of adiponectin with all-cause and cardiovascular mortality. Mean ؎ SD age was 52 ؎ 12 yr, and mean ؎ SD glomerular filtration rate (GFR) rate was 33 ؎ 12 ml/min per 1.73 m 2 . Eighty-five percent of participants were white, and 60% were male. Mean ؎ SD adiponectin was 12.8 ؎ 8.0 g/ml. Triglycerides, insulin resistance, glucose, body mass index, GFR, C-reactive protein, and albumin were inversely related and proteinuria and HDL cholesterol were directly related to adiponectin. During the 10-year follow-up period, 201 (25%) participants died of any cause, and 122 (15%) from cardiovascular disease. In multivariable adjusted Cox models, a 1-g/ml increase in adiponectin was associated with a 3% (hazard ratio 1.03; 95% confidence interval 1.01 to 1.05; P ‫؍‬ 0.02) increased risk for all-cause and 6% (hazard ratio 1.06; 95% confidence interval 1.03 to 1.09; P < 0.001) increased risk for cardiovascular mortality. High, rather than low, adiponectin is associated with increased mortality in this cohort of patients with chronic kidney disease stages 3 to 4. Further studies are necessary to confirm this association and to elucidate the underlying mechanisms. A diponectin is an adipocyte-derived peptide that may possess antiatherogenic properties (1,2). Obesity (3), coronary artery disease (4 -6), and diabetes (7) are characterized by low adiponectin levels, suggesting an inverse association with cardiovascular disease (CVD) risk. Whereas prospective studies in diabetic and nondiabetic men have demonstrated an inverse relationship between adiponectin levels and risk for CVD events (5,6), this association was not found in women (8) and in a population-based cohort of American Indians (9). On the contrary, in a few studies, high rather than low adiponectin levels were associated with adverse outcomes in patients with type 1 diabetes (10,11) and heart failure (12).Kidney function is an important determinant of circulating levels of adiponectin (13,14), and levels of this protein are markedly elevated in kidney failure (15). Data on the relationship between adiponectin and outcomes in patients with chronic kidney disease (CKD) are sparse. Low adiponectin levels were associated with increased risk for CVD events in one study of hemodialysis patients (15). Similarly, there was an inverse correlation between adiponectin levels and incident CVD in univariate analyses in a small cohort of patients in the earlier stages of CKD (13). Using data from the random...

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Leptin/Adiponectin Ratio is an Independent Predictor of Mortality in Nondiabetic Peritoneal Dialysis Patients

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Mechanisms Linking Obesity, Chronic Kidney Disease, and Fatty Liver Disease

“…Others observed similar inverse correlations in cross-sectional studies 49,50 ; however, the association between adiponectin levels and kidney disease is complex. There is a direct correlation between adiponectin levels and overt proteinuria, [51][52][53] and studies report conflicting data between adiponectin levels and mortality in patients with CKD or coronary artery disease. 36, 54 -56 Nonetheless, the inverse correlation between adiponectin and low-grade albuminuria prompted us to investigate whether a relative adiponectin deficiency has a causative role in abnormal glomerular function.…”