Abstract
BackgroundA few studies have investigated the role of adiponectin fraction for cardiovascular disease (CVD) in RTx recipients.Subjects and MethodsWe studied 57 adult subjects (39 males, 18 females; 10 cadaveric donors) with at least three years of allograft survival (median 251 months). We examined clinical backgrounds such as treated drugs, blood pressure (BP, mmHg), body mass index (BMI), and blood chemistry including cholesterol (total, LDL-C, HDL-C), glucose, glycated hemoglobin (HbA1c), and serum high and low-molecular-weight (HMW/LMW) ADPN fractions with regard to the associations of the visceral and subcutaneous fat areas on CT scan. We also analyzed the associations of CVD and post-transplant diabetes (PTDM) with ADPN fractions and the fat areas.ResultsThe visceral fat area was inversely correlated with serum HMW and LMW ADPN levels and HMW ADPN ratio (r = -0.400, p = 0.002 and r = -0.296, p = 0.025 and r = -0.444, p<0.001, respectively). Furthermore, the visceral fat area was positively with the LMW ADPN ratio (r = 0.467, p<0.001), but no significant correlation was noted between the subcutaneous fat area and the ADPN ratio. On multiple regression analysis, eGFR and the visceral fat area were significant reducing factors of HMW ADPN levels, and the alteration of eGFR was identified as an increasing factor of HMW ADPN levels. Patients with CVD had larger visceral fat area (p = 0.004), lower HMW ADPN ratio (p = 0.022) and higher LMW ADPN ratio (p = 0.049). In addition, the higher HMW ADPN ratio and statin treatment were identified as reducing factors of the development of CVD, but the LDL-C level was an aggravating factor. Moreover, the higher LMW ADPN ratio and the visceral fat area were aggravating factors of PTDM.ConclusionEven in Japanese renal transplant recipients, visceral fat area and ADPN fractions were significant factors for the development of both CVD and PTDM.
Highlights
The causes of chronic renal graft failure have been roughly classified into immunological and non-immunological, with dyslipidemia, which belongs to the latter, influencing renal graft function
The visceral fat area was inversely correlated with serum HMW and LMW ADPN levels and HMW ADPN ratio (r = -0.400, p = 0.002 and r = -0.296, p = 0.025 and r = -0.444, p
The visceral fat area was positively with the LMW ADPN ratio (r = 0.467, p
Summary
The causes of chronic renal graft failure have been roughly classified into immunological and non-immunological, with dyslipidemia, which belongs to the latter, influencing renal graft function. From the viewpoint of chronic kidney disease (CKD), complications of the cardiovascular system following kidney transplantation have a strong impact on the prognosis of renal graft recipients, for whom the factors constituting metabolic syndrome (obesity, diabetes, hypertension, and dyslipidemia) as well as transplantation-related immunosuppressors, the state of CKD, proteinuria, and anemia are important[1, 2]. ADPN has been reported to improve insulin sensitivity and exert anti-diabetic, anti-arteriosclerotic, and anti-inflammatory effects [3]. Reductions in ADPN plasma levels promote arteriosclerotic cardiovascular events, hypertension, and dyslipidemia[4]. Regarding ADPN, a previous study reported that its high-molecular-weight (HMW) dodecamer and 18-mer, but not its monomer or trimer were closely associated with the prevention of coronary arterial disease, weight loss effects, and improved insulin resistance [7]. The relationships between post-transplant diabetes mellitus (PTDM) and CVD and the ADPN fraction in renal transplant patients have not yet been examined. A few studies have investigated the role of adiponectin fraction for cardiovascular disease (CVD) in RTx recipients
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