Nephrology Division, Yitzhak Shamir Medical Center, Zerifin, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Zerifin, Israel.
Internal Department D, Yitzhak Shamir Medical Center, Zerifin, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Zerifin, Israel.
Sci Rep. 2021 Apr 27;11(1):9087. doi: 10.1038/s41598-021-88558-0.
Despite experimental evidence of beneficial metabolic, antiatherosclerotic and antiinflammatory effects of the 30 kDa adipokine, adiponectin, maintenance hemodialysis (MHD) patients with high adiponectin blood levels have paradoxically high mortality rates. We aimed to examine the direction of the associations between adiponectin and all-cause and cardiovascular mortality as well as with markers of oxidative stress, inflammation and nutrition in MHD patients with varying degrees of comorbidities. A cohort of 261 MHD patients (mean age 68.6 ± 13.6 years, 38.7% women), grouped according to baseline comorbidity index (CI) and serum adiponectin levels, were followed prospectively for six years. High and low concentrations were established according to median CI and adiponectin levels and cross-classified. Across the four CI-adiponectin categories, the group with low comorbidities and high adiponectin exhibited the best outcomes. Conversely, the high comorbidity group with high adiponectin levels had the lowest survival rate in both all-cause mortality (log rankχ = 23.74, p < 0.001) and cardiovascular mortality (log rankχ = 34.16, p < 0.001). Further data adjustment for case-mix covariates including fat mass index did not substantially affect these results. In conclusion, the direction of adiponectin's prognostic associations in MHD patients is inverse in those with few comorbidities and direct in those with many comorbidities.
尽管 30kDa 脂肪因子脂联素具有有益的代谢、抗动脉粥样硬化和抗炎作用的实验证据，但血液中脂联素水平较高的维持性血液透析（MHD）患者的死亡率却出奇地高。我们旨在研究脂联素与全因和心血管死亡率以及与氧化应激、炎症和营养标志物之间的关联方向，这些标志物在具有不同合并症程度的 MHD 患者中存在。我们对 261 名 MHD 患者（平均年龄 68.6±13.6 岁，38.7%为女性）进行了前瞻性研究，这些患者根据基线合并症指数（CI）和血清脂联素水平进行分组，随访时间为六年。根据中位数 CI 和脂联素水平确定高、低浓度，并进行交叉分类。在四个 CI-脂联素类别中，低合并症和高脂联素的组表现出最佳的结果。相反，高合并症组和高脂联素水平的组在全因死亡率（对数秩 χ2=23.74，p<0.001）和心血管死亡率（对数秩 χ2=34.16，p<0.001）方面的存活率最低。进一步调整包括脂肪质量指数在内的病例组合协变量后，这些结果并没有实质性的影响。总之，在合并症较少的 MHD 患者中，脂联素的预后相关性呈负向，而在合并症较多的患者中则呈正向。
