Chemerin: A biomarker for cardiovascular disease in diabetic chronic kidney disease patients

Abstract

Cardiovascular disease is the leading cause of morbidity and mortality in patients with chronic kidney disease (CKD). The carotid intima-media thickness (CIMT) and arterial stiffness are useful markers of subclinical atherosclerosis and significantly correlate with various metabolic risk factors. Chemerin is one of the adipokines that may represent a link between obesity and inflammation and may be a potential candidate playing a role in the pathogenesis of atherosclerosis and cardiovascular complications. Therefore, we studied the relationship of chemerin levels with atherosclerosis as measured by CIMT in diabetic CKD patients, either predialysis or on hemodialysis (HD). In addition, we studied its correlation with other cardiovascular risk factors such as interleukin-6 (IL-6) and insulin resistance (IR). Fifty-eight patients were enrolled in the study; 23 patients with CKD (11 are diabetic) on conservative treatment and 35 (18 are diabetic) on maintenance HD. Serum concentrations of chemerin and IL-6 were determined by ELISA. All participants underwent measurements of CIMT by highresolution ultrasonography. A stepwise increase in serum chemerin levels was found depending on the glomerular filtration rate: 286.6 ± 10.02 ng/mL in the control group, 332.1 ± 21.54 ng/mL in the predialysis group, and 355.7 ± 20 ng/mL in the HD group. A significant rise of serum chemerin level was observed in diabetic CKD patients either on conservative therapy or on HD when compared with nondiabetic CKD patients. Moreover, there was a significant difference in serum levels of chemerin, IL-6, CIMT, serum insulin, and homeostasis model assessment of IR (HOMA-IR) between diabetic and nondiabetic patients in both groups. Chemerin showed a significant positive correlation with HOMA-IR, serum insulin, and C-reactive protein. In conclusion, serum chemerin level was found to be an independent predictive marker of the presence of atherosclerosis in patients with CKD either on conservative treatment or on HD.

Chemical Pathology of Chemerin and Its Link to Obesity and Type 2 Diabetes Mellitus: A Review

“…They identified chemerin as a novel adipocytokine regulating and enhancing insulin signaling in fat. Conclusively, they found that chemerin is an independent predictive marker of atherosclerosis in patients with chronic kidney disease [19]. Further review by Shehata et al indicates that chemerin is known to regulate fat formation and metabolism.…”

Traditional, Nontraditional, and Uremia-Related Threats for Cardiovascular Disease in Chronic Kidney Disease

“…Therefore, it is crucial to improving care for the patient with diabetes before he enters the end-stage of the disease. Diabetic patients with underlying CKD face an increased cardiac risk after developing acute MI, which is mirrored through atrial and ventricular arrhythmia, atrioventricular (AV) block, asystole, pulmonary congestion and cardiogenic shock [40].…”

Upregulation of Nrf2 and Decreased Redox Signaling Contribute to Renoprotective Effects of Chemerin Receptor Blockade in Diabetic Mice

“…High circulating levels of chemerin are also associated with progression of kidney dysfunction [18] and chronic inflammation, insulin resistance, and disorders of glucose and lipid metabolism, which are abnormalities commonly observed in chronic kidney disease (CKD) [19,20]. In patients with severe renal damage, this adipokine is expressed in tubular epithelial cells and lymphatic endothelial vessels and has been identified as a product of endothelial and proximal tubular epithelial cells.…”

“…Although chemerin has been associated with insulin resistance in cardiomyocytes and skeletal muscle cells [34,35] and with kidney disease [18,19], the role of the chemerin/ChemR23 system in renal function in the context of diabetes has not been fully elucidated. We previously showed that increased plasma chemerin is associated with hyperglycemia in obese diabetic db/db mice [36].…”