title: Differential effect of baseline adiponectin on all-cause mortality in hemodialysis patients depending on initial body mass index. Long-term follow-up data of 4.5 years.
abstract: OBJECTIVE
  We sought to investigate the interaction of adiponectin levels and body mass index (BMI) for predicting all-cause mortality in a cohort of hemodialysis (HD) patients.
  
  
  METHODS
  Longitudinal, observational cohort study.
  
  
  METHODS
  HD unit.
  
  
  METHODS
  Sixty patients (mean age: 64 ± 13 years, 39 men) with end-stage renal disease on maintenance HD followed up for 4.5 years represented the prospective study cohort.
  
  
  METHODS
  Associations between baseline plasma adiponectin levels and initial BMI with all-cause mortality were assessed taking into account the assumption of nonlinear correlations. The association between adiponectin, BMI, and serum levels of interleukin-10 (IL-10) and interleukin-6 (IL-6) with survival was determined cross-sectionally.
  
  
  METHODS
  All-cause mortality.
  
  
  RESULTS
  Nonlinear survival modeling showed that there was a U-shaped association of BMI with all-cause mortality, whereas there was an inverse U-shaped association for plasma adiponectin levels. Using a BMI of 24 kg/m(2) as a cutoff, an interaction effect of BMI on the association between adiponectin and mortality was observed (P = .045). In participants with BMI ≥ 24 kg/m(2), each 15 μg/mL increase in plasma adiponectin levels was associated with a decreased hazard of death (hazard ratio: 0.57, 95% CI: 0.32 to 0.99) in unadjusted analysis. In HD patients with BMI < 24 kg/m(2), no significant association was observed between adiponectin and mortality (P = .989). Cross-sectional analysis showed that in the subgroup of patients in whom the protective effect of adiponectin was observed (BMI ≥ 24 kg/m(2)), a positive linear association existed between adiponectin and IL-10 levels (r = 0.345, P = .027) as well as a negative association with IL-6 levels (r = -0.322, P = .040). No association was observed in patients with BMI < 24 kg/m(2), neither with IL-10 nor with IL-6.
  
  
  CONCLUSIONS
  Obesity possibly modifies the effect of adiponectin on all-cause mortality in HD patients, thus explaining the published conflicting results in recent literature regarding the association of plasma adiponectin levels and mortality in chronic kidney disease patients.
authors.affiliation: Microbiology Department, Medical School, Democritus University of Thrace, Alexandroupolis, Greece. xtsigalou@yahoo.gr
authors.forename: Christina
authors.initials: C
authors.lastname: Tsigalou
authors.forename: Georgios
authors.initials: G
authors.lastname: Chalikias
authors.forename: Konstantina
authors.initials: K
authors.lastname: Kantartzi
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Tziakas
authors.forename: Georgia
authors.initials: G
authors.lastname: Kampouromiti
authors.forename: Vassilis
authors.initials: V
authors.lastname: Vargemezis
authors.forename: Stavros
authors.initials: S
authors.lastname: Konstantinides
authors.forename: Sofia
authors.initials: S
authors.lastname: Ktenidou-Kartali
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Simopoulos
authors.forename: Ploumis
authors.initials: P
authors.lastname: Passadakis
mesh_terms: D052242:Adiponectin / Q000097:blood*; D000368:Aged; D015992:Body Mass Index; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016753:Interleukin-10 / Q000097:blood; D015850:Interleukin-6 / Q000097:blood; D007676:Kidney Failure, Chronic / Q000097:blood / Q000401:mortality; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D006435:Renal Dialysis / Q000401:mortality*
chemical_list: D052242:Adiponectin; D015850:Interleukin-6; D016753:Interleukin-10