Serum Adiponectin Levels and Mortality after Kidney Transplantation

Abstract

SummaryBackground and objectives Adiponectin (ADPN), an adipose tissue-derived hormone, has protective properties with respect to atherogenesis, inflammation, and energy homeostasis. Its beneficial role has not been consistent in patients with CKD or those undergoing dialysis.Design, setting, participants, & measurements This study examined the association of plasma ADPN levels in 987 prevalent kidney transplant recipients (mean age 6 SD, 51.0612.8 years; estimated GFR, 52.8621.9 ml/min per 1.73 m 2 ; median time since transplant, 78 months) on all-cause mortality and death-censored graft failure. Patients were enrolled between February and August 2007 and were followed for a median of 51 months (interquartile range, 49-53 months). Using Cox proportional hazard models, the association of log-transformed plasma adiponectin was studied, with and without adjustment for demographic variables, baseline GFR, markers of inflammation, and cardiovascular risk factors.Results At baseline, patients in the lowest ADPN tertile were significantly more likely to be male; to be smokers; to have a higher baseline GFR, lower systolic BP, and lower HDL cholesterol level; and to have higher body mass index, abdominal circumference, C-reactive protein level, and total cholesterol level. The adjusted hazard ratio for death with elevated plasma ADPN (per natural log) was 1.44, and there was no significant interaction with any relevant cardiovascular risk subgroups (i.e., advanced age; diabetes; or elevated body mass index, waist circumference, C-reactive protein, or Framingham risk score). The hazard for death-censored graft failure was nonsignificant at 1.03.Conclusion Elevated ADPN levels are associated with higher risk for death but not allograft failure in prevalent kidney transplant recipients.

Circulating adiponectin and cardiovascular mortality in patients with type 2 diabetes mellitus: evidence of sexual dimorphism

“…Despite the direct association between serum adiponectin and CV mortality is difficult to reconcile with the well-recognized role of adiponectin as an anti inflammatory, anti-atherogenic and insulin sensitizer factor [2,3] and with the previously reported association with reduced risk of CHD [6,7,27], the same counter intuitive finding has been recently described in individuals from the general population and several selected clinical setting [11–17,19–23]. In addition, high adiponectin levels have been reported to predict all-cause mortality in the general population and in patients with CV disease [18–21], as well as in elderly people with type 2 diabetes [44].…”

“…Thus, it is surprising that, high adiponectin levels predict increased risk of heart failure (HF) [9,10] as well as CV mortality in the general population and in selected clinical settings [11–21]. A similar unexpected paradoxical association with the risk of CV mortality has been also described in patients with type 1 diabetes [22] and in kidney transplant recipients [23]. Whether this is the case also among patients with type 2 diabetes has never been addressed.…”

Adiponectin in inflammatory and immune-mediated diseases

“…To summarize, circulating levels of APN are high in patients with chronic kidney failure, particularly in end-stage renal disease. Elevated levels of APN in this population are positively correlated with markers of systemic inflammation and associated with higher risk of death [89]. Although clearance of APN is mostly mediated by the liver [90], reduced renal excretion - rather than suppressed production by adipocytes - has been proposed as the mechanism for the elevated circulating levels of APN in chronic kidney disease [9, 88].…”

“…Serum APN levels increase with progression of chronic graft-versus-host disease (GVHD) after allogeneic stem cell transplantation and decrease as GVHD improves, indicating a positive association between APN and GVHD severity [108]. In recipients of kidney transplants, low levels of APN predict allograft failure [109], although a different study demonstrates that elevated APN levels are not associated with protection from transplant failure [89]. As mentioned above, contradictory, possibly strain-dependent, results have also been reported for the role of APN in mouse models of heart and skin transplantation [55, 56, 72].…”

Ocena stężenia adypocytokin u dzieci z przewlekłą chorobą nerek

“…In CKD various adipocytokines could play a role enhancing endothelial dysfunction, oxidative stress, inflammation, atherosclerosis, kidney sympathetic activity, blood pressure, and anaemia [24,25]. Alam et al revealed that elevated adiponectin concentration is linked to higher risk for death in adult CKD patients after kidney transplantation [26]. However, they did not document the higher rate of allograft failure in these patients.…”