Serum adiponectin and progression of diabetic nephropathy in patients with type 1 diabetes.
OBJECTIVE
The purpose of this study was to elucidate whether serum adiponectin is associated with progression of diabetic nephropathy in type 1 diabetic patients.


METHODS
This was a prospective follow-up study as a part of the nationwide Finnish Diabetic Nephropathy Study; 1,330 type 1 diabetic patients were followed for 5.0 +/- 2.2 years. Patients were divided at baseline into three groups according to their urinary albumin excretion rate (AER) in three consecutive overnight or 24-h urine collections: 818 patients with normoalbuminuria (AER <20 microg/min), 216 patients with microalbuminuria (20 microg/min <or= AER < 200 microg/min), and 296 patients with macroalbuminuria (AER >or=200 microg/min). Progression of albuminuria was the main outcome. Adiponectin was measured by a time-resolved immunofluorometric assay, and the values were log-transformed and adjusted for age, BMI, and sex before analysis.


RESULTS
Progression either to the next albuminuria level or to end-stage renal disease (ESRD) occurred in 193 patients. No difference in adiponectin concentrations was observed between progressors and nonprogressors in patients with normoalbuminuria or microalbuminuria. In the patients with macroalbuminuria, progression to ESRD was associated with higher adiponectin in the entire group (23.4 +/- 17.1 vs. 16.0 +/- 8.5 mg/l, P < 0.001) and in men (P < 0.001) and women (P < 0.001) separately. Progression to ESRD was also associated with systolic blood pressure, insulin dose, A1C, serum cholesterol, serum triglycerides, AER, and estimated glomerular filtration rate (eGFR). When these covariates were inserted in a Cox regression analysis, A1C, triglycerides, eGFR, and adiponectin were significantly associated with progression from macroalbuminuria.


CONCLUSIONS
Increased serum adiponectin levels predict the progression from macroalbuminuria to ESRD in type 1 diabetic patients.
Saraheimo
Markku
M
Folkhälsan Institute of Genetics, Folkhälsan Research Center, Biomedicum Helsinki, Helsinki, Finland.
Forsblom
Carol
C
Thorn
Lena
L
Wadén
Johan
J
Rosengård-Bärlund
Milla
M
Heikkilä
Outi
O
Hietala
Kustaa
K
Gordin
Daniel
D
Frystyk
Jan
J
Flyvbjerg
Allan
A
Groop
Per-Henrik
PH
D052242:Adiponectin / Q000097:blood*; D000328:Adult; D000419:Albuminuria / Q000097:blood; D015992:Body Mass Index; D003922:Diabetes Mellitus, Type 1 / Q000097:blood* / Q000150:complications*; D003928:Diabetic Nephropathies / Q000097:blood* / Q000453:epidemiology*; D018450:Disease Progression; D005260:Female; D005387:Finland / Q000453:epidemiology; D005500:Follow-Up Studies; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests
D052242:Adiponectin