Department of Nephrology, Theodor Bilharz Research Institute, Cairo, Egypt.
Kidney Blood Press Res. 2012;35(4):247-53. doi: 10.1159/000334649. Epub 2012 Jan 26.
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.
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.
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.
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.
脂联素（ADPN）水平在晚期慢性肾脏病患者中始终升高，但在该人群中其与心血管结局的关系仍存在争议。我们的研究目的是测量维持性血液透析（HD）的终末期肾病患者的血浆 ADPN 水平，并研究其与心血管结局和死亡率的相关性。
我们的研究包括 133 名 HD 患者（79 名男性和 54 名女性），平均年龄为 54.6 ± 17.3 岁，他们在埃及开罗 Theodor Bilharz 研究所的肾病科接受至少 6 个月的常规 HD。研究了血浆 ADPN 水平与临床和生化指标的相关性，并前瞻性地检测了 HD 患者中 ADPN 水平对心血管事件和死亡率的预测能力，这些患者被监测了 24 ± 9 个月。通过使用敏感的酶联免疫吸附试验测量血浆 ADPN 水平。
HD 患者（18.1 ± 6.8 μg/ml）的血浆 ADPN 水平比健康受试者（6.2 ± 1.8 μg/ml）高 3 倍（p < 0.0001）。发生新心血管事件的患者（13.9 ± 6.4 μg/ml）的血浆 ADPN 水平低于无事件患者（18.6 ± 8.4 μg/ml）（p < 0.007）。与组 2（ADPN ≥15.1 μg/ml）相比，组 1（ADPN <15.1 μg/ml）患者发生心血管事件的相对风险高 1.96 倍（95%置信区间 1.290-2.977，p = 0.0016）。血浆 ADPN 水平与 BMI、胰岛素水平、稳态模型评估指数值、甘油三酯和 LDL-C、CRP 和左心室质量指数呈负相关。此外，血浆 ADPN 水平与 HDL-C 呈正相关。
血浆 ADPN 是 HD 患者心血管事件和死亡率的独立（负相关）预测因子。ADPN 与几种代谢危险因素之间的关系方向表明 ADPN 在预防 CVD 方面具有保护作用。
