In hemodialysis, adiponectin, and pro‐brain natriuretic peptide levels may be subjected to variations in body mass index

Abstract

Adiponectin exerts cardiovascular protective actions, although some studies have shown the opposite. In hemodialysis, obese subjects display lower mortality rates despite hypoadiponectinemia, while higher adiponectin concentrations correlate with an elevated cardiovascular risk in nonobese subjects. The aim of the study is to suggest that adiponectin level variations are associated with differences in the body mass index (BMI). The interplay between adiponectin and pro-brain natriuretic peptide (Pro-BNP) levels may vary according to body fat mass. Fifty-two chronic hemodialysis patients were divided into three groups. Group A, BMI<25 (n=20); Group B, BMI 25 to 30 (n=21), and Group C, BMI>30 (n=11). Diabetics: Group A 10%; Group B 6 29%; Group C 55%, P=0.027. Determinations: Adiponectin, Pro-BNP, insulin, insulin resistance (HOMA), troponin T, nutritional status, ultrafiltration rates, C-reactive protein (CRP), vascular accesses, and echocardiography. Group A: adiponectinemia positively and significantly correlated with Pro-BNP, CRP, and troponin T. As BMI increased, adiponectin, Pro-BNP, and malnutrition significantly decreased, while insulin, HOMA, and ultrafiltration rates significantly increased. Cardiac restriction was significantly higher in obese patients. In all groups, Pro-BNP and troponin T displayed a strong positive correlation. In low-BMI subjects, high Pro-BNP and adiponectin, low myocardial restriction, and worse nutritional status were prevalent. In obesity, hypoadiponectinemia stimulates cardiac remodeling, cardiac hypertrophy, and decreased stretching, rendering Pro-BNP levels low despite high ultrafiltration rates. Thus, adiponectin correlates inversely with BMI, probably playing different cardiovascular roles as BMI changes.

Residual urinary output in high body mass index individuals on chronic hemodialysis: A disregarded life vest?

“…This increase in insulin could also reflect an insulin-resistant state in high BMI patients, which is inherent to obese individuals [44,45] . In addition, in our study high BMI was associated with lower Pro-BNP levels, which is in agreement with other publications that report the association between hyperinsulinemia and low Pro-BNP patients in obesity [15,[45][46][47] . In our study, leptin is significantly high in GC, where its correlation with insulin is positive and significant.…”

“…This hemodynamic situation is also illustrated by the fact that albumin is negatively correlated with TropT and Pro-BNP, two cardiovascular biomarkers that are increased in overfilling states and myocardial stretching [34][35][36][37][38][39] (Table 3). Although we reported significantly low ProBNP levels in high BMI individuals, we could not demonstrate this phenomenon in the present work [15] (Table 2). It is possible that this smoother hemodynamic setting could explain in part one of the causes of a higher survival rate in high BMI subjects.…”

“…In this regard, some studies have found an inverse association between obesity and diuresis, while this association has also been reported to be inconclusive [28,29] . In addition, insulin and particularly hyperinsulinemia itself due to peripheral tissue resistance and deeply involved in the pathogenesis of metabolic syndrome and obesity, has been reported to be elevated in high BMI individuals on HD [15,30] . Insulin causes myocardial hypertrophy and water and salt retention and is associated with diabetes and hypertension, conditions that contribute to high morbidity and mortality rates, particularly in end stage kidney disease [31] .…”

“…In this regard, there is a negative correlation between BMI and death, generally referred to as the obesity paradox [12] . In hemodialysis individuals, obesity seems to act as a protective factor [13,14] and in general, obese subjects display a better nutritional status, regardless of portraying a more severe cardiac condition [15] . While diabetes and obesity are two usually associated conditions, in HD diabetics tend to present increased morbidity and mortality rates but obesity has been reported to display better survival.…”

A comparison of markers of myocardial injury and their relation to nutritional parameters in hemodialysis patients

“…A few studies investigated this relation by the way but none of them used anthropometric parameters except for body mass index. 23,24 However, classic anthropometric parameters are more specific than body mass index or albumin in the evaluation of nutrition, as they estimate the percentage of body fat and body muscle. Inverse correlations of troponin T and anthropometric parameters have not been reported before.…”