Adipokines and Nutritional Status for Patients on Maintenance Hemodialysis

Adiponectin and end-stage renal disease

“…95 In two recent studies, serum adiponectin levels in HD patients were reported to have positive correlations with the subjective global assessment and malnutrition-inflammation score and also negative correlations with BMI, meaning that well-nourished HD patients with higher BMI were found to have lower serum adiponectin levels compared to malnourished HD patients with lower BMI. 96,97 Increased adiponectin has been proposed as being a "reparatory response" to the microvascular insults in uremia. 98 However, rodent experimental data indicate that adiponectin may also induce protein-energy wasting by increasing energy expenditure and inducing weight loss through a direct effect on the brain.…”

“…99 Unlike among the healthy population, in HD patients obesity is paradoxically associated with better outcomes, meaning that patients with higher BMI body have better nutritional status. 96 However, the effect of overweight or obesity on survival of PD patients is less clear with contradictory results. 102,103 Due to the inverse relationship between adiponectin and fat mass, HD patients with higher adiponectin have lower BMI and subsequently higher risk for mortality.…”

Sensitivity and Specificity of Body Mass Index as a Marker of Obesity in Elderly Patients on Hemodialysis

“…34,35 Corroborating these findings, Sharma et al 19 showed that throughout all CKD stages, there were patients classified as obese by BMI and DXA who had low appendicular lean mass index, a recognized marker of sarcopenia. Altogether, BMI is clearly not an accurate marker of obesity.…”

Malnutrition, Inflammation and Reverse Epidemiology in Hemodialysis Patients

“…Cholesterol metabolism in HP can be significantly altered by dialysis protocol, lipid controlling medication, malnutrition, and inflammation (Montazerifar, Hashemi, Karajibani, & Dikshit, 2010). HDL can be significantly reduced in HP due to a reduced plasma concentration of ApoA-I and ApoA-II (Bowden, Hebert, Wilson, Gentile, & Lanning, 2007;Vaziri, 2009), reduced transporter proteins such as ABCA-1 (Vaziri, 2009), and the downregulation of enzymatic process associated with HDL maturation (Malgorzewicz et al, 2010). Down-regulation also occurs with HDL paraoxonase which is associated with impaired protection against oxidative stress.…”