Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
PLoS One. 2019 Jul 19;14(7):e0220158. doi: 10.1371/journal.pone.0220158. eCollection 2019.
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.
脂联素是循环中含量最丰富的脂肪因子，具有胰岛素增敏和抗炎作用。虽然有人推测，与脂联素升高相关的肾功能下降归因于肾脏清除率降低和对脂联素抵抗的代偿反应，但尚不清楚脂联素升高如何影响慢性肾脏病 (CKD) 患者的临床结局，以及这些影响是否与普通人群相同。因此，本研究旨在探讨非糖尿病 CKD 患者血清脂联素水平与临床结局的相关性是否独立于肥胖和代谢综合征。我们纳入了 196 名 eGFR 为 10-60 mL/min/1.73 m2 的非糖尿病 CKD 患者，这些患者根据是否存在代谢综合征分为两组。主要终点是全因死亡率或肾脏事件（需要肾脏替代治疗[RRT]的肾衰竭或 eGFR 降低 50%）。在平均 5 年的随访期间，观察到 48 例（24.5%）终末期肾病（ESRD）事件，33 例（16.8%）死亡。平均 eGFR 为 29.8 ± 12.8 mL/min/1.73 m2。队列的基线中位数脂联素浓度为 29.4（四分位距，13.3-108.7）μg/ml。脂联素水平与体重指数（BMI）呈负相关（r = -0.29；P < 0.001），与腰围呈负相关（r = -0.35；P < 0.001）。在完全调整的 Cox 回归模型中，RRT 的风险比（HR）为 2.08（95%置信区间[CI]，1.08-4.02；P = 0.03），复合肾脏结局的 HR 为 1.66（95%CI，1.03-2.65；P = 0.04）。在不同亚组中风险保持一致。然而，与死亡率风险无关。总之，脂联素水平升高与 ESRD 风险增加相关，独立于传统危险因素、BMI 和代谢综合征成分。
