title: Clinical importance of an elevated circulating chemerin level in incident dialysis patients.
abstract: BACKGROUND
  Circulating chemerin, a novel adipokine linked to obesity, glucose tolerance and hyperlipidaemia, was recently reported to be increased in chronic kidney disease (CKD) patients. We explored possible links between chemerin and various clinical, nutritional and biochemical markers as well as its association with 5-year all-cause mortality.
  
  
  METHODS
  Fasting plasma samples were obtained from 252 CKD Stage 5 patients [median age 56 years, male 61%, glomerular filtration rate (GFR) 7 mL/min] enrolled at the initiation of dialysis. Serum chemerin was measured using commercial ELISA. Chemerin levels were related to clinical status and biomarkers of inflammation, glucose and lipid metabolism and body composition (body mass index and total and truncal fat mass by dual-energy X-ray absorptiometry). Survival, censored for transplantation, was recorded for a follow-up time of 5 years.
  
  
  RESULTS
  In univariate regression, circulating chemerin (119 ± 26 ng/mL) was positively correlated with cholesterol (ρ = 0.21; P = 0.001), triglycerides (ρ = 0.22; P = 0.0007), apolipoprotein B (ρ = 0.33; P < 0.0001), high-sensitivity C-reactive protein (ρ = 0.18; P = 0.006), white blood cell count (ρ = 0.23; P < 0.001), insulin (ρ = 0.18; P < 0.05) and homeostatic model assessment (HOMA) index (ρ = 0.17; P < 0.05), whereas we found a negative correlation with GFR (ρ = -0.28; P = 0.007), high-density lipoprotein cholesterol (ρ = -0.15; P < 0.05) and homocysteine (ρ = -0.25; P = 0.001). Moreover, a high chemerin predicted a better survival (log-rank χ(2) = 3.85; P < 0.05). Also, in a Cox model, adjustments for age, sex and CRP did not alter this finding (hazard ratio = 1.98 [95% confidence interval = 1.13-3.50], P = 0.01). However, adjusting for GFR made the model non-significant.
  
  
  CONCLUSIONS
  We report that, in incident dialysis patients, an elevated chemerin is associated with a survival advantage despite its significant positive association with markers of inflammation and dyslipidaemia.
authors.affiliation: Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden.
authors.forename: Tae
authors.initials: T
authors.lastname: Yamamoto
authors.forename: Abdul Rashid
authors.initials: AR
authors.lastname: Qureshi
authors.forename: Björn
authors.initials: B
authors.lastname: Anderstam
authors.forename: Olof
authors.initials: O
authors.lastname: Heimbürger
authors.forename: Peter
authors.initials: P
authors.lastname: Bárány
authors.forename: Bengt
authors.initials: B
authors.lastname: Lindholm
authors.forename: Peter
authors.initials: P
authors.lastname: Stenvinkel
authors.forename: Jonas
authors.initials: J
authors.lastname: Axelsson
mesh_terms: D015415:Biomarkers / Q000097:blood; D018925:Chemokines / Q000097:blood*; D002908:Chronic Disease; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D036341:Intercellular Signaling Peptides and Proteins; D053208:Kaplan-Meier Estimate; D007674:Kidney Diseases / Q000097:blood / Q000401:mortality* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D006435:Renal Dialysis; D012720:Severity of Illness Index; D015996:Survival Rate
chemical_list: D015415:Biomarkers; D018925:Chemokines; D036341:Intercellular Signaling Peptides and Proteins; C478630:RARRES2 protein, human