title: Association of Adiponectin With Body Composition and Mortality in Hemodialysis Patients.
abstract: BACKGROUND
  In the general population, circulating adiponectin is associated with a favorable cardiovascular risk profile (eg, lower triglycerides and body fat) and decreased mortality. Hemodialysis (HD) patients have comparatively higher adiponectin concentrations, but prior studies examining the adiponectin-mortality association in this population have not accounted for body composition or shown a consistent relationship.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  We examined baseline serum adiponectin concentrations in 501 HD patients across 13 dialysis centers from the prospective MADRAD (Malnutrition, Diet, and Racial Disparities in Chronic Kidney Disease) cohort (entry period, October 2011 to February 2013; follow-up through August 2013).
  
  
  METHODS
  Serum adiponectin concentration in tertiles (tertiles 1, 2, and 3 defined as ≤16.1, >16.1-<30.1, and ≥30.1-100.0 μg/mL, respectively). Adjustment variables included case-mix and laboratory test results (age, sex, race, ethnicity, vintage, diabetes, serum albumin, total iron-binding capacity, serum creatinine, white blood cell count, phosphate, hemoglobin, and normalized protein catabolic rate), body composition surrogates (subcutaneous, visceral, and total-body fat and lean body mass), and serum lipid levels (cholesterol, high-density lipoprotein cholesterol, and triglycerides).
  
  
  RESULTS
  All-cause mortality using survival (Cox) models incrementally adjusted for case-mix and laboratory test results.
  
  
  RESULTS
  Among 501 HD patients, 50 deaths were observed during 631.1 person-years of follow-up. In case-mix- and laboratory-adjusted Cox analyses, the highest adiponectin tertile was associated with increased mortality versus the lowest tertile (HR, 3.35; 95% CI, 1.50-7.47). These associations were robust in analyses that additionally accounted for body composition (HR, 3.18; 95% CI, 1.61-8.24) and lipid levels (HR, 3.64; 95% CI, 1.34-7.58).
  
  
  CONCLUSIONS
  Residual confounding cannot be excluded.
  
  
  CONCLUSIONS
  Higher adiponectin level is associated with a 3-fold higher death risk in HD patients independent of body composition and lipid levels. Future studies are needed to elucidate underlying mechanisms and determine therapeutic targets associated with improved outcomes in HD patients.
authors.affiliation: Harold Simmons Center of Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, Orange, CA. Electronic address: crhee1@uci.edu.
authors.forename: Connie M
authors.initials: CM
authors.lastname: Rhee
authors.affiliation: Division of General Internal Medicine, University of California Irvine, Orange, CA.
authors.forename: Danh V
authors.initials: DV
authors.lastname: Nguyen
authors.affiliation: Harold Simmons Center of Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, Orange, CA.
authors.forename: Hamid
authors.initials: H
authors.lastname: Moradi
authors.affiliation: DaVita Healthcare Partners Inc, Minneapolis, MN.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Brunelli
authors.affiliation: Division of Nephrology, Harbor-UCLA Medical Center, Torrance, CA.
authors.forename: Ramanath
authors.initials: R
authors.lastname: Dukkipati
authors.affiliation: Harold Simmons Center of Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, Orange, CA.
authors.forename: Jennie
authors.initials: J
authors.lastname: Jing
authors.affiliation: Harold Simmons Center of Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, Orange, CA.
authors.forename: Tracy
authors.initials: T
authors.lastname: Nakata
authors.affiliation: University of Tennessee Health Science Center, Memphis, TN; Division of Nephrology, Memphis VA Medical Center, Memphis, TN.
authors.forename: Csaba P
authors.initials: CP
authors.lastname: Kovesdy
authors.affiliation: Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, CA.
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Brent
authors.affiliation: Harold Simmons Center of Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, Orange, CA.
authors.forename: Kamyar
authors.initials: K
authors.lastname: Kalantar-Zadeh
mesh_terms: D052242:Adiponectin / Q000097:blood*; D000328:Adult; D000368:Aged; D001823:Body Composition; D002318:Cardiovascular Diseases / Q000097:blood; D008076:Cholesterol, HDL / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood; D015331:Cohort Studies; D005260:Female; D006801:Humans; D050152:Intra-Abdominal Fat; D007676:Kidney Failure, Chronic / Q000097:blood* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009026:Mortality; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D006435:Renal Dialysis; D050151:Subcutaneous Fat; D014280:Triglycerides / Q000097:blood
chemical_list: D052242:Adiponectin; D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D014280:Triglycerides
keywords: Adiponectin; MADRAD (Malnutrition, Diet, and Racial Disparities in Chronic Kidney Disease) study; anthropometry; body composition; body fat; body mass index (BMI); cardiovascular disease (CVD); end-stage renal disease; hemodialysis; lipids; mortality; renal replacement therapy (RRT)
references.citation: Metabolism. 2007 Sep;56(9):1201-8
references.pmid: 17697862
references.citation: J Clin Invest. 2007 Feb;117(2):375-86
references.pmid: 17256056
references.citation: Nephrol Dial Transplant. 2008 Aug;23(8):2619-28
references.pmid: 18334528
references.citation: J Am Coll Cardiol. 2009 Apr 14;53(15):1265-72
references.pmid: 19358939
references.citation: J Am Coll Cardiol. 2009 Jun 2;53(22):2070-7
references.pmid: 19477358
references.citation: Clin Nephrol. 2009 Aug;72(2):87-96
references.pmid: 19640365
references.citation: Kidney Int. 2009 Sep;76(5):567-75
references.pmid: 19516245
references.citation: J Ren Nutr. 2009 Sep;19(5):357-64
references.pmid: 19596588
references.citation: Am J Nephrol. 2009;30(3):244-52
references.pmid: 19468209
references.citation: J Investig Med. 2010 Mar;58(3):554-9
references.pmid: 20215915
references.citation: Kidney Int. 2010 Apr;77(7):624-9
references.pmid: 20072111
references.citation: Am J Kidney Dis. 2010 May;55(5):885-96
references.pmid: 20346558
references.citation: Clin J Am Soc Nephrol. 2010 Dec;5(12):2258-68
references.pmid: 20947789
references.citation: J Intern Med. 2011 Feb;269(2):172-81
references.pmid: 21138492
references.citation: Hemodial Int. 2012 Jul;16(3):334-41
references.pmid: 22497657
references.citation: Biochimie. 2012 Oct;94(10):2150-6
references.pmid: 22980197
references.citation: J Ren Nutr. 2013 Jan;23(1):45-56
references.pmid: 22406123
references.citation: Semin Nephrol. 2013 Jan;33(1):2-13
references.pmid: 23374889
references.citation: J Ren Nutr. 2013 May;23(3):203-6
references.pmid: 23611547
references.citation: Prog Cardiovasc Dis. 2014 Jan-Feb;56(4):415-25
references.pmid: 24438733
references.citation: Nephrol Dial Transplant. 2014 Aug;29(8):1554-62
references.pmid: 24574544
references.citation: Cardiovasc Diabetol. 2014;13:103
references.pmid: 24957699
references.citation: Circulation. 2000 Sep 12;102(11):1296-301
references.pmid: 10982546
references.citation: Circulation. 2001 Feb 27;103(8):1057-63
references.pmid: 11222466
references.citation: Nat Med. 2001 Aug;7(8):941-6
references.pmid: 11479627
references.citation: Nat Med. 2001 Aug;7(8):947-53
references.pmid: 11479628
references.citation: J Clin Endocrinol Metab. 2001 Aug;86(8):3815-9
references.pmid: 11502817
references.citation: J Am Soc Nephrol. 2002 Jan;13(1):134-41
references.pmid: 11752030
references.citation: Diabetologia. 2003 Apr;46(4):459-69
references.pmid: 12687327
references.citation: Diabetes Care. 2003 Aug;26(8):2442-50
references.pmid: 12882876
references.citation: J Biol Chem. 2003 Nov 7;278(45):45021-6
references.pmid: 12944390
references.citation: J Biol Chem. 2003 Dec 12;278(50):50810-7
references.pmid: 14522956
references.citation: Kidney Int. 2004 Jan;65(1):274-81
references.pmid: 14675060
references.citation: Circ Res. 2004 Mar 5;94(4):e27-31
references.pmid: 14752031
references.citation: JAMA. 2004 Apr 14;291(14):1730-7
references.pmid: 15082700
references.citation: J Am Coll Cardiol. 2004 Apr 21;43(8):1439-44
references.pmid: 15093881
references.citation: Nat Med. 2004 May;10(5):524-9
references.pmid: 15077108
references.citation: Am J Kidney Dis. 2004 Jun;43(6):1047-55
references.pmid: 15168385
references.citation: Biochem Biophys Res Commun. 2004 Oct 15;323(2):630-5
references.pmid: 15369797
references.citation: Nephrol Dial Transplant. 1999 Jan;14(1):169-75
references.pmid: 10052499
references.citation: Biochem Biophys Res Commun. 1999 Apr 2;257(1):79-83
references.pmid: 10092513
references.citation: J Ren Nutr. 2005 Jan;15(1):142-7
references.pmid: 15648024
references.citation: Diabetes. 2005 Feb;54(2):534-9
references.pmid: 15677512
references.citation: Circulation. 2005 Feb 15;111(6):747-53
references.pmid: 15699257
references.citation: J Lipid Res. 2005 Nov;46(11):2398-404
references.pmid: 16106049
references.citation: Am J Clin Nutr. 2006 Feb;83(2):202-10
references.pmid: 16469976
references.citation: Mol Endocrinol. 2006 Jul;20(7):1673-87
references.pmid: 16497731
references.citation: J Am Soc Nephrol. 2006 Sep;17(9):2599-606
references.pmid: 16885405
references.citation: J Am Soc Nephrol. 2007 Jan;18(1):293-303
references.pmid: 17167113
references.citation: Intern Med. 2008;47(6):485-91
references.pmid: 18344634