title: Adiponectin and mortality in patients with chronic kidney disease.
abstract: Adiponectin is presumed to possess antiatherogenic and cardioprotective properties. Limited data exist on the relationship between adiponectin and mortality in the earlier stages of chronic kidney disease. The Modification of Diet in Renal Disease study was a randomized, controlled trial that was conducted between 1989 and 1993. Adiponectin was measured in frozen samples that were obtained at baseline (N = 820). Survival status and cause of death, up to December 31, 2000, were obtained from the National Death Index. Multivariable Cox models were used to examine the relationship of adiponectin with all-cause and cardiovascular mortality. Mean +/- SD age was 52 +/- 12 yr, and mean +/- SD glomerular filtration rate (GFR) rate was 33 +/- 12 ml/min per 1.73 m2. Eighty-five percent of participants were white, and 60% were male. Mean +/- SD adiponectin was 12.8 +/- 8.0 mug/ml. Triglycerides, insulin resistance, glucose, body mass index, GFR, C-reactive protein, and albumin were inversely related and proteinuria and HDL cholesterol were directly related to adiponectin. During the 10-year follow-up period, 201 (25%) participants died of any cause, and 122 (15%) from cardiovascular disease. In multivariable adjusted Cox models, a 1-mug/ml increase in adiponectin was associated with a 3% (hazard ratio 1.03; 95% confidence interval 1.01 to 1.05; P = 0.02) increased risk for all-cause and 6% (hazard ratio 1.06; 95% confidence interval 1.03 to 1.09; P < 0.001) increased risk for cardiovascular mortality. High, rather than low, adiponectin is associated with increased mortality in this cohort of patients with chronic kidney disease stages 3 to 4. Further studies are necessary to confirm this association and to elucidate the underlying mechanisms.
authors.affiliation: Tufts-New England Medical Center, Division of Nephrology, 750 Washington Street, NEMC #391, Boston, MA 02111, USA. vmenon@tufts-nemc.org
authors.forename: Vandana
authors.initials: V
authors.lastname: Menon
authors.forename: Lijun
authors.initials: L
authors.lastname: Li
authors.forename: Xuelei
authors.initials: X
authors.lastname: Wang
authors.forename: Tom
authors.initials: T
authors.lastname: Greene
authors.forename: Vaidyanathapuram
authors.initials: V
authors.lastname: Balakrishnan
authors.forename: Magdalena
authors.initials: M
authors.lastname: Madero
authors.forename: Arema A
authors.initials: AA
authors.lastname: Pereira
authors.forename: Gerald J
authors.initials: GJ
authors.lastname: Beck
authors.forename: John W
authors.initials: JW
authors.lastname: Kusek
authors.forename: Allan J
authors.initials: AJ
authors.lastname: Collins
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Levey
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Sarnak
mesh_terms: D052242:Adiponectin / Q000097:blood*; D000328:Adult; D002318:Cardiovascular Diseases / Q000401:mortality; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D016032:Randomized Controlled Trials as Topic; D016019:Survival Analysis; D014481:United States / Q000453:epidemiology
chemical_list: D052242:Adiponectin