The association of adiponectin with metabolic syndrome and clinical outcome in patients with non-diabetic chronic kidney disease

• Published in: PloS one 2019-07, Vol.14 (7), p.e0220158-e0220158
• Main Authors: Kuo, I-Ching, Wu, Ping-Hsun, Lin, Hugo You-Hsien, Niu, Sheng-Wen, Huang, Jiun-Chi, Hung, Chi-Chih, Chiu, Yi-Wen, Chen, Hung-Chun
• Format: Article
• Language: English
• Subjects: Adiponectin; Adiponectin - blood; Adiponectin - metabolism; Adipose tissue; Adult; Aged; Aged, 80 and over; Analysis; Anti-inflammatory agents; Biology and Life Sciences; Biomarkers; Body fat; Body mass; Body mass index; Body size; Cardiovascular disease; Chronic kidney failure; Confidence intervals; Diabetes; Diabetes mellitus; EDTA; End-stage renal disease; Epidermal growth factor receptors; Family medical history; Female; Hemodialysis; Hospitals; Humans; Inflammation; Insulin; Insulin resistance; Internal medicine; Kidney diseases; Kidney failure; Kidneys; Male; Medicine; Medicine and Health Sciences; Metabolic disorders; Metabolic syndrome; Metabolic Syndrome - blood; Metabolic Syndrome - etiology; Metabolic Syndrome - metabolism; Metabolic syndrome X; Middle Aged; Mortality; Nephrology; Obesity; Outcome and process assessment (Medical care); Oxidative stress; Physiology; Population; Prognosis; Protein hormones; Regression models; Renal failure; Renal Insufficiency, Chronic - complications; Renal Insufficiency, Chronic - diagnosis; Review boards; Risk analysis; Risk factors; Sensitizing; Signal transduction; Statistical analysis; Studies; Subgroups; Transplants & implants; Type 2 diabetes; Urine; Young Adult
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0220158

Adiponectin is the most abundant circulating adipokine, and it has insulin-sensitizing and anti-inflammatory properties. Although it has been speculated that kidney function decline associated with elevated adiponectin is attributable to decreased renal clearance and compensatory responses to adiponectin resistance, it is unclear how elevated adiponectin affects clinical outcomes in chronic kidney disease (CKD) patients and whether the effects are the same as those in the general population. Therefore, the aim of this study is to examine whether the association between serum adiponectin levels and clinical outcomes in non-diabetic CKD patients is independent of adiposity and metabolic syndrome. We enrolled 196 non-diabetic CKD patients with eGFR ranging between 10 and 60 mL/min/1.73 m2, these patients were divided into two groups based on the presence of metabolic syndrome. The primary endpoint was all-cause mortality or renal events (renal failure requiring renal replacement therapy [RRT] or 50% reduction in eGFR). During the mean follow-up period of 5 years, 48 (24.5%) incident cases of end-stage renal disease (ESRD) were observed, and 33 (16.8%) deaths occurred. The mean eGFR was 29.8 ± 12.8 mL/min/1.73m2. The baseline median adiponectin concentration in the cohort was 29.4(interquartile range, 13.3-108.7) μg/ml. Adiponectin levels were inversely related to body mass index (BMI) (r = -0.29; P < 0.001) and waist circumference (r = -0.35; P < 0.001). In the fully adjusted Cox regression model, the hazard ratios (HRs) were 2.08 (95% confidence interval [CI], 1.08-4.02; P = 0.03) for RRT and 1.66 (95% CI, 1.03-2.65; P = 0.04) for composite renal outcome. The risks remained consistent within different subgroups. However, no association was observed with mortality risk. In conclusion, higher adiponectin levels are associated with a higher risk of ESRD independent of conventional risk factors, BMI, and metabolic syndrome components.