Adiponectin and Cardiovascular Outcomes among Hemodialysis Patients

Abstract

Background: Adiponectin (ADPN) levels are consistently elevated among patients with advanced chronic kidney disease, but its relationship with cardiovascular outcomes in this population remains controversial. The aim of our study was to measure the plasma levels of ADPN in patients with end-stage renal disease on maintenance hemodialysis (HD) and we studied its correlates to cardiovascular outcomes and mortality. Methods: Our study included 133 HD patients (79 male and 54 female patients) with a mean age of 54.6 ± 17.3 years who had been receiving regular HD for at least 6 months in the nephrology units of Theodor Bilharz Research Institute, Cairo, Egypt. The clinical and biochemical correlates of plasma ADPN levels were investigated and the predictive power of ADPN levels with respect to cardiovascular events and mortality was prospectively tested in HD patients, who were monitored for 24 ± 9 months. Plasma ADPN levels were measured by using a sensitive enzyme-linked immunosorbent assay. Results: Plasma ADPN levels were 3 times higher (p < 0.0001) among HD patients (18.1 ± 6.8 µg/ml) than among healthy subjects (6.2 ± 1.8 µg/ml). Plasma ADPN levels were lower (p < 0.007) among patients who experienced new cardiovascular events (13.9 ± 6.4 µg/ml) than among event-free patients (18.6 ± 8.4 µg/ml). The relative risk of cardiovascular events was 1.96 times (95% confidence interval 1.290–2.977, p = 0.0016) higher among patients in group 1 (ADPN <15.1 µg/ml), compared with those in group 2 (ADPN ≥15.1 µg/ml). Plasma ADPN levels were inversely related to BMI, insulin levels, homeostatic model assessment index values, triglyceride and LDL-C, CRP and left ventricular mass index. Furthermore, plasma ADPN levels were directly related to HDL-C. Conclusion: Plasma ADPN is an independent (inverse) predictor of cardiovascular events and mortality among HD patients. The directions of the relationships between ADPN and several metabolic risk factors indicate that ADPN has a protective role in prevention of CVD.