Rao Madhumathi, Li Lijun, Tighiouart Hocine, Jaber Bertrand L, Pereira Brian J G, Balakrishnan Vaidyanathapuram S
Division of Nephrology, Department of Medicine, Tufts-New England Medical Center Hospitals, Box 391, 750 Washington Street, Boston, MA 02111, USA.
Nephrol Dial Transplant. 2008 Aug;23(8):2619-28. doi: 10.1093/ndt/gfn070. Epub 2008 Mar 11.
Adiponectin (ADPN) levels are consistently elevated among patients with advanced chronic kidney disease, but its relationship with cardiovascular outcomes in this population remains controversial.
We measured baseline and yearly plasma ADPN in 182 prevalent haemodialysis patients recruited to the Haemodialysis (HEMO) Study from two Boston centres. Plasma ADPN at baseline and during follow-up was studied in relation to prevalent cardiovascular disease (CVD) and cardiovascular and all-cause mortality.
Baseline plasma ADPN levels were found to be approximately twofold higher than in the general population and correlated inversely with (log-transformed) CRP levels and (log-transformed) body mass index (BMI). Levels measured over time showed a gradual increase (0.95 microg/mL, 95% CI = 0.12-1.78 microg/mL; P = 0.03) by year, although this difference became non-significant after adjustment for covariates. Baseline ADPN levels were lower among patients with pre-existing CVD (adjusted OR of 0.67; P = 0.03). They also predicted all-cause mortality (P < 0.01) and the composite outcome of 'cardiovascular events/cardiovascular mortality' (P < 0.01); levels measured over time predicted the composite outcome of 'cardiovascular events and all-cause mortality' (P < 0.01). These relationships were non-linear (quadratic) with the hazard for each outcome increasing in the lower and upper ranges of the distribution of ADPN, and strengthened after adjustment for baseline covariates including serum albumin, CVD and the flux and dialysis dose categorization of the HEMO study.
In summary, low plasma levels of ADPN were associated with inflammation and pre-existing CVD; ADPN levels predicted cardiovascular and mortality outcomes, the relationship being extensively confounded by multiple patient-related factors.
晚期慢性肾病患者的脂联素（ADPN）水平持续升高，但其与该人群心血管结局的关系仍存在争议。
我们测量了从波士顿两个中心招募到血液透析（HEMO）研究中的182例维持性血液透析患者的基线和年度血浆ADPN水平。研究了基线和随访期间的血浆ADPN与心血管疾病（CVD）、心血管及全因死亡率的关系。
发现基线血浆ADPN水平比普通人群高约两倍，且与（对数转换后的）CRP水平和（对数转换后的）体重指数（BMI）呈负相关。随时间测量的水平显示每年逐渐升高（0.95微克/毫升，95%可信区间=0.12 - 1.78微克/毫升；P = 0.03），但在调整协变量后这种差异变得不显著。已有CVD的患者基线ADPN水平较低（调整后的比值比为0.67；P = 0.03）。它们还可预测全因死亡率（P < 0.01）和“心血管事件/心血管死亡率”的复合结局（P < 0.01）；随时间测量的水平可预测“心血管事件和全因死亡率”的复合结局（P < 0.01）。这些关系是非线性（二次）的，每种结局的风险在ADPN分布的较低和较高范围内增加，并且在调整包括血清白蛋白、CVD以及HEMO研究的通量和透析剂量分类等基线协变量后得到加强。
总之，低血浆ADPN水平与炎症和已有CVD相关；ADPN水平可预测心血管和死亡结局，这种关系受到多种患者相关因素的广泛混淆。
