Plasma adiponectin concentration has an inverse and a non linear association with estimated glomerular filtration rate in patients with K/DOQI 3 - 5 chronic kidney disease.
BACKGROUND
Chronic kidney disease (CKD) is associated with an increased incidence of cardiovascular disease (CVD). A few studies have demonstrated elevated plasma adiponectin and leptin levels in CKD. The aims of this study were to assess whether 1) estimated glomerular filtration rate (eGFR) is associated with plasma leptin and adiponectin; and 2) adiponectin and leptin (partly) explain associations of CKD with endothelial dysfunction, insulin resistance, and low-grade inflammation in patients with K/DOQI Stage 3 - 5 CKD.


METHODS
Baseline data from 91 patients with Stage 3 - 4 CKD in the anti-oxidant therapy in chronic renal insufficiency study, a randomized, double-blind, placebo-controlled trial, in which the effects of oxidative stress-lowering treatment on vascular function and structure were studied, and from 50 dialysis naïve patients, who took part in an open-label, randomized study that compared two peritoneal dialysis regimens, used in the analysis. All subjects for both the studies were recruited in the same centres.


RESULTS
The association between eGFR and adiponectin was non-linear. In multivariate analysis, log-eGFR (unstandardized beta = 8.303 microg/ml, p < 0.0001) was the strongest determinant of adiponectin, and body mass index the strongest determinant of leptin (beta = 2.477 ng/ml, p < 0.0001). Plasma adiponectin and leptin did not modify the associations between eGFR and plasma von Willebrand factor or soluble vascular adhesion molecule-1. Plasma leptin had the strongest association with the homeostatic model assessment (HOMA-IR) index. Plasma C-reactive protein had no association with adiponectin or leptin.


CONCLUSIONS
In patients with K/DOQI Stage 3 - 5 CKD, renal function had a significant non-linear inverse association with and was the strongest predictor of adiponectin. BMI was the strongest predictor of plasma leptin. Plasma adiponectin and leptin did not explain, and thus presumably are not involved in, the association between eGFR and some markers of endothelial dysfunction.
Nanayakkara
P W P
PW
Department of Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands. p.nanayakkara@vumc.nl
Le Poole
C Y
CY
Fouque
D
D
van Guldener
C
C
Stehouwer
C D A
CD
Smulders
Y M
YM
van Ittersum
F J
FJ
Siegert
C E H
CE
Drai
J
J
Kostense
P J
PJ
ter Wee
P M
PM
D052242:Adiponectin / Q000097:blood*; D000975:Antioxidants / Q000627:therapeutic use; D015992:Body Mass Index; D003430:Cross-Sectional Studies; D004311:Double-Blind Method; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007249:Inflammation / Q000097:blood; D007333:Insulin Resistance; D007676:Kidney Failure, Chronic / Q000097:blood* / Q000628:therapy; D007677:Kidney Function Tests; D020738:Leptin / Q000097:blood; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010530:Peritoneal Dialysis; D014841:von Willebrand Factor / Q000378:metabolism
D052242:Adiponectin; D000975:Antioxidants; D020738:Leptin; D014841:von Willebrand Factor