Waist circumference modifies the relationship between the adipose tissue cytokines leptin and adiponectin and all-cause and cardiovascular mortality in haemodialysis patients.
BACKGROUND
the relationships between the adipose tissue cytokines leptin and adiponectin (ADPN) and clinical outcomes have not been well studied in haemodialysis (HD) patients and remain highly controversial. As central obesity is an important modifier of the effect of various risk factors for clinical outcomes, we tested the hypothesis that waist circumference (WC) modifies the link between these cytokines and both overall and cardiovascular death in HD patients.


METHODS
a total of 537 HD patients participated in a prospective cohort study.


RESULTS
leptin and ADPN were inversely related to each other and robustly associated with WC (P < 0.001). During follow-up (average 29 months, range 1-47 months) 182 patients died, including 115 from cardiovascular causes. In analyses adjusting for potential confounders, there were strong interactions between leptin and WC in relationship to both all-cause (P < 0.001) and cardiovascular death (P = 0.002). Accordingly, a fixed excess of leptin signalled a gradually increasing risk for all-cause and cardiovascular mortality in patients with a large WC but an opposite effect in those with a relatively small WC. An interaction between ADPN and WC for all-cause (P = 0.01) and cardiovascular mortality (P = 0.01) emerged only in models excluding the leptin-WC interaction, suggesting that these adipokines share a common pathway leading to adverse clinical events in HD patients.


CONCLUSIONS
the predictive value of leptin and ADPN for all-cause and cardiovascular death in HD patients appears to be critically dependent on WC. These findings support the hypothesis that disturbances in adipokine levels are involved in adverse clinical outcomes in HD patients with abdominal obesity.
Nephrology, Dialysis and Transplantation Unit and CNR-IBIM Clinical Epidemiology and Pathophysiology of Renal Diseases and Hypertension, Reggio Calabria, Italy. carmine.zoccali@tin.it
C
C
Zoccali
M
M
Postorino
C
C
Marino
P
P
Pizzini
S
S
Cutrupi
G
G
Tripepi
D052242:Adiponectin / Q000032:analysis*; D000273:Adipose Tissue / Q000737:chemistry; D000368:Aged; D000886:Anthropometry / Q000379:methods; D015415:Biomarkers / Q000032:analysis; D002318:Cardiovascular Diseases / Q000209:etiology* / Q000378:metabolism / Q000401:mortality; D004812:Epidemiologic Methods; D005260:Female; D006439:Hemodynamics; D006801:Humans; D007558:Italy / Q000453:epidemiology; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000378:metabolism / Q000401:mortality / Q000628:therapy; D020738:Leptin / Q000032:analysis*; D008297:Male; D008875:Middle Aged; D056128:Obesity, Abdominal / Q000150:complications / Q000378:metabolism / Q000401:mortality; D006435:Renal Dialysis; D055105:Waist Circumference
D052242:Adiponectin; D015415:Biomarkers; D020738:Leptin