Association of Adiponectin with High-Sensitivity C-Reactive Protein and Clinical Outcomes in Peritoneal Dialysis Patients: A 3.5-Year Follow-Up Study

Abstract

IntroductionAdiponectin (ADPN), one of most abundant fat-derived biologically active substances, plays an important role in anti-atherosclerotic process. There are conflicting results about the impact of ADPN on cardiovascular (CV) outcomes and mortality, particularly in patients undergoing peritoneal dialysis (PD). Moreover, the relationship between ADPN and inflammatory mediators has been seldom explored in this population. Therefore, we examined the relationship between ADPN and longitudinal high-sensitivity C-reactive protein (hs-CRP) changes and investigated whether ADPN or hs-CRP levels could predict CV outcomes and mortality in prevalent PD patients after comprehensive adjustment of possible confounders.MethodsIn this prospective cohort study, 78 PD patients were enrolled and followed from February 2009 to August 2012. During follow-up, CV events and all-cause mortality were recorded.ResultsThe mean baseline ADPN value was 29.46±18.01 μg/ml and duration of PD treatment was 37.76±36.96 months. In multiple linear regression analysis, plasma ADPN levels positively correlated with high-density lipoprotein and negatively associated with hs-CRP, body mass index, D4/D0 glucose, triglyceride, and duration of PD treatment. After stratified by genders, the inverse association between baseline ADPN and hs-CRP was more significant in the female group. The hs-CRP levels were followed up annually and remained significantly lower in the high ADPN group in the first 2 years. Patients were then stratified into two groups according to the median ADPN value (23.8 μg/ml). The results of Kaplan-Meier survival analysis demonstrated less CV events and better survival in high ADPN group. On multivariate Cox regression analysis, only ADPN level (HR: 0.93, 95% CI: 0.88–0.98, p = 0.02), age and history of CV diseases were independent risk factors for future CV events. Furthermore, hs-CRP (HR: 1.11, 95% CI:1.001–1.22, p = 0.04) was identified as independent predictor of all-cause mortality.ConclusionsSerum hs-CRP levels were consistently lower in the high ADPN group during 2-year follow-up. We also demonstrated the importance of ADPN and hs-CRP in predicting CV events and all-cause mortality in PD population during 3.5-year follow-up.

Adiponectin and end-stage renal disease

“…37 Furthermore, in PD patients, adiponectin levels have been found to be inversely associated with D4/D0 glucose and duration of PD treatment. 47 The underlying cause of the higher levels of circulating adiponectin in kidney disease is still unclear. It has been postulated that the elevated adiponectin levels observed in ESRD are a reflection of decreased renal clearance.…”

“…7,45,64,83 Other studies support the hypothesis that high adiponectin predicts increased cardiovascular mortality in ESRD patients. [84][85][86] According to a recent study by Tung et al 47 specifically in PD patients during a 3.5-year follow-up, the results of the Kaplan-Meier survival analysis demonstrated fewer cardiovascular events and better survival in high adiponectin patients. On multivariate Cox regression analysis, only adiponectin level, age and history of cardiovascular diseases were independent risk factors for future cardiovascular events.…”

“…7,45,64,83,85,86,101 A recent 3.5-year follow-up study by Tung et al 47 investigated the association of adiponectin and clinical outcomes, specifically in the least studied ESRD population, prevalent PD patients. Their results demonstrate better survival in high adiponectin patients.…”

Circulating Adiponectin Levels Are Paradoxically Associated With Mortality Rate: A Systematic Review and Meta-Analysis

“…The number of subjects for the association between total adiponectin and all-cause mortality was 61,676, with an overall event rate of 25% when excluding studies with an unknown number of events (11,26,70). This meta-analysis was powered at 90% (assuming a type I error of 0.05) to detect an HR #1.03 (SD 1).…”

Low serum adiponectin level is associated with central arterial stiffness in patients undergoing peritoneal dialysis

“…Moreover, in vitro studies, reactive oxygen species induced by conventional glucose-based PD dialysate fluid contribute to downregulate the adiponectin secreted from adipocytes [ 12 ]. Low serum adiponectin level is an independent predictor of CV events, and mortality among patients undergoing hemodialysis and PD [ 13 14 ]. CV disease is a leading cause of death in PD patients [ 15 ].…”