Differential Effect of Baseline Adiponectin on All-Cause Mortality in Hemodialysis Patients Depending on Initial Body Mass Index. Long-Term Follow-Up Data of 4.5 Years

Tsigalou, Christina; Chalikias, Georgios K.; Kantartzi, Konstantina; Tziakas, Dimitrios; Kampouromiti, Georgia; Vargemezis, Vassilis; Konstantinides, Stavros; Ktenidou-Kartali, Sofia; Simopoulos, Konstantinos; Passadakis, Ploumis

doi:10.1053/j.jrn.2011.12.007

Cited by 20 publications

(20 citation statements)

References 33 publications

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“…15 In the largest study of adiponectin and mortality in dialysis patients to date, Dreschler et al found that higher adiponectin concentrations were associated with increased risk of sudden cardiac death among 1255 HD patients with diabetes type 2 from 4D (Die Deutsche Diabetes Dialyse), although estimates were no longer significant after adjustment for BMI, serum lipids (TG, HDL) and other covariates. 13 Two recent studies by Zoccali et al and Tsigalou et al show that the adiponectin–mortality association is dependent upon underlying BMI and waist circumference 16,17 , but none of the aforementioned studies have concurrently adjusted for individual body composition components (e.g., LBM and visceral, subcutaneous, and total body fat).…”

Section: Discussionmentioning

confidence: 99%

“…13–15 Heterogeneous findings across studies may be due to residual confounding relating to inconsistent covariate adjustment. 16,17 Previous studies of the adiponectin–mortality association in this population have not comprehensively considered differences in multiple individual body composition compartments (e.g., visceral and subcutaneous fat mass or lean body mass [LBM]) among patients with varying adiponectin levels. Furthermore, only two studies have accounted for serum lipid components in non–dialysis-dependent chronic kidney disease and HD patients to date.…”

mentioning

confidence: 99%

“…19–21 Indeed, recent data suggest that the association between adiponectin and mortality may be dependent upon BMI or waist circumference. 16,17 To date, to our knowledge, no studies of adiponectin and mortality have comprehensively accounted for differences in other body composition components such as subcutaneous fat and LBM. Furthermore, some, 22–25 but not all, 26 studies have shown that total serum cholesterol and its individual components such as LDL and HDL have paradoxical associations with mortality in HD patients (i.e., lower total and LDL cholesterol and higher HDL cholesterol associated with increased death risk).…”

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Association of Adiponectin With Body Composition and Mortality in Hemodialysis Patients

Rhee

Nguyen

Moradi

et al. 2015

American Journal of Kidney Diseases

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Background In the general population, circulating adiponectin is associated with a favorable cardiovascular risk profile (e.g., 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 nor shown a consistent relationship. Study Design Prospective cohort study. Settings and 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 10/2011-2/2013, follow-up through 8/2013). Predictor Serum adiponectin concentration in tertiles (Tertiles 1, 2, and 3 defined as <=16.1, >16.1–30.1, >30.1–100.0 ug/ml, respectively). Adjustment variables included case-mix and laboratory tests (age, sex, race, ethnicity, vintage, diabetes, serum albumin, total iron binding capacity, serum creatinine, white blood cell count, phosphate, hemoglobin, normalized protein catabolic rate), body composition surrogates (subcutaneous, visceral, and total body fat; lean body mass), and serum lipid levels (cholesterol, HDL, triglycerides). Outcomes All-cause mortality using survival (Cox) models incrementally adjusted for case-mix and laboratory tests. Results Among 501 HD patients, 50 deaths were observed during 631.1 person-years of follow-up time. In case-mix– and laboratory-adjusted Cox analyses, the highest adiponectin tertile was associated with increased mortality vs. 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 lipids (HR, 3.64; 95% CI, 1.34–7.58). Limitations Residual confounding cannot be excluded. Conclusions In conclusion, higher adiponectin is associated with a 3-fold higher death risk in HD patients independent of body composition and lipids. Future studies are needed to elucidate underlying mechanisms, and to determine therapeutic targets associated with improved outcomes in HD patients.

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Association of Adiponectin With Body Composition and Mortality in Hemodialysis Patients

Rhee

Nguyen

Moradi

et al. 2015

American Journal of Kidney Diseases

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“…104,105 According to Tsigalou and colleagues, the differential effect of adiponectin regarding survival on dialysis patients probably resides in the obesity-inflammation association. 106 They found a U-shaped association of BMI with all-cause mortality in HD patients and an inverse U-shaped association for plasma adiponectin levels and all-cause mortality. The authors postulate that the beneficial effects of adiponectin on inflammatory imbalance are only evident in the presence of adiposity and in the absence of protein-energy wasting.…”

Section: Adiponectin and Outcome In Esrdmentioning

confidence: 96%

Adiponectin and end-stage renal disease

Markaki¹,

Psylinakis²,

Spyridaki³

2016

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Adiponectin (ADPN) is an adipokine with significant anti-inflammatory, insulin-sensitizing and anti-atherogenic properties, which is generally associated with a beneficial cardiometabolic profile. Paradoxically, end-stage renal disease (ESRD) is characterized by markedly increased plasma ADPN levels and increased cardiovascular risk. In spite of the cardioprotective properties attributed to adiponectin, cardiovascular complications remain the main cause of mortality in the ESRD population. Furthermore, these patients have enhanced chronic inflammation, increased insulin resistance and persistent protein-energy wasting. Studies of the impact of ADPN on clinical outcomes among ESRD patients have so far yielded contradictory results. This review article summarizes the current knowledge on ADPN functions and explores the role of ADPN in ESRD patients, with specific focus on inflammation, insulin resistance, cardiovascular disease and wasting.

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“…They conclude that obesity or malnutrition is the driving factor for hyperadiponectinemia and that the increase in adiponectin levels is linked with mortality in ESRD patients. [28]…”

Section: Levels Of Adiponectin and Established Kidney Diseasementioning

confidence: 99%

Adiponectin effects on the kidney

Sweiss

Sharma

2014

Best Practice & Research Clinical Endocrinology & Metab

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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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Differential Effect of Baseline Adiponectin on All-Cause Mortality in Hemodialysis Patients Depending on Initial Body Mass Index. Long-Term Follow-Up Data of 4.5 Years

Cited by 20 publications

References 33 publications

Association of Adiponectin With Body Composition and Mortality in Hemodialysis Patients

Association of Adiponectin With Body Composition and Mortality in Hemodialysis Patients

Adiponectin and end-stage renal disease

Adiponectin effects on the kidney

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