Suh Sang Heon, Oh Tae Ryom, Choi Hong Sang, Kim Chang Seong, Lee Joongyub, Oh Yun Kyu, Jung Ji Yong, Lee Kyu-Beck, Oh Kook-Hwan, Ma Seong Kwon, Bae Eun Hui, Kim Soo Wan
Department of Internal Medicine, Chonnam National University Medical School and Chonnam National University Hospital, Gwangju, South Korea.
Department of Prevention and Management, School of Medicine, Inha University, Incheon, South Korea.
Front Cardiovasc Med. 2022 Jan 13;8:789488. doi: 10.3389/fcvm.2021.789488. eCollection 2021.
Serum adiponectin level predicts cardiovascular (CV) outcomes and progression of coronary artery calcification (CAC) in the general population, although the association has not been validated in patients with chronic kidney disease (CKD). In this study, we investigated the association of high serum adiponectin level with the risk of adverse CV outcomes and progression of CAC in patients with pre-dialysis CKD. A total of 1,127 patients with pre-dialysis CKD from a nationwide prospective cohort of patients with pre-dialysis CKD in Korea were divided into the tertile by serum adiponectin level at the baseline. CV outcome of interest was fatal and non-fatal CV events and all-cause mortality. Progression of CAC was defined as coronary artery calcium score (CACS) change more than 200 during a 4-year follow-up. Cox regression analysis revealed that high serum adiponectin is associated with increased risk of fatal and non-fatal CV events (adjusted hazard ratio 2.799, 95% CI 1.348-5.811). In contrast, high serum adiponectin level was not significantly associated with all-cause mortality (adjusted hazard ratio 0.655, 95% CI 0.203-2.113). Binary logistic regression analysis revealed that high serum adiponectin level is also associated with increased risk of progression of CAC (adjusted odds ratio [OR] 2.078, 95% CI 1.014-4.260). Subgroup analyses demonstrated that the association of high serum adiponectin with increased risk of fatal and non-fatal CV events is not modified by age, gender, history of diabetes, estimated glomerular filtration rate (eGFR), or spot urine albumin-to-creatinine ratio (ACR). High serum adiponectin level is associated with adverse CV outcomes and progression of CAC in patients with pre-dialysis CKD.
血清脂联素水平可预测普通人群的心血管（CV）结局及冠状动脉钙化（CAC）进展，尽管该关联尚未在慢性肾脏病（CKD）患者中得到验证。在本研究中，我们调查了高血清脂联素水平与透析前CKD患者不良CV结局风险及CAC进展之间的关联。韩国一项全国性透析前CKD患者前瞻性队列研究中的1127例透析前CKD患者，根据基线时血清脂联素水平分为三分位数。感兴趣的CV结局为致命性和非致命性CV事件及全因死亡率。CAC进展定义为4年随访期间冠状动脉钙化评分（CACS）变化超过200。Cox回归分析显示，高血清脂联素与致命性和非致命性CV事件风险增加相关（调整后风险比2.799，95%CI 1.348 - 5.811）。相比之下，高血清脂联素水平与全因死亡率无显著关联（调整后风险比0.655，95%CI 0.203 - 2.113）。二元逻辑回归分析显示，高血清脂联素水平也与CAC进展风险增加相关（调整后比值比[OR] 2.078，95%CI 1.014 - 4.260）。亚组分析表明，高血清脂联素与致命性和非致命性CV事件风险增加之间的关联不受年龄、性别、糖尿病史、估计肾小球滤过率（eGFR）或随机尿白蛋白与肌酐比值（ACR）的影响。高血清脂联素水平与透析前CKD患者的不良CV结局及CAC进展相关。
