title: Adiponectin predicts cardiovascular events in diabetes dialysis patients.
abstract: OBJECTIVE
  Adiponectin is an insulin-sensitizing, anti-inflammatory adipokine with anti-atherogenic actions in the general population. In dialysis patients it is unclear whether adiponectin conserves its protective value or is, on the contrary, associated to worse prognosis. We assessed the predictive value of adiponectin for atherosclerosis related cardiovascular events in type 2 diabetic dialysis patients.
  
  
  METHODS
  Prevalent diabetic dialysis patients from three dialysis units (n=77) were enrolled in a 3years' prospective observational study. Serum adiponectin, clinical and laboratory parameters were determined at baseline; new occurrence of atherosclerosis related events (coronary events, atherosclerosis obliterans, and stroke) was recorded.
  
  
  RESULTS
  Baseline adiponectin was 17.25(9.53-31.97) μg/mL and significantly correlated to HDL cholesterol (r=0.29, p=0.01), triglycerides (r=-0.40, p=0.0004), ferritin (r=-0.29, p=0.02), transferrin (r=-0.28, p=0.02), and uric acid (r=-0.24, p=0.04). In multivariate analysis association to triglycerides (p=0.001), HDL cholesterol (p=0.01) and ferritin (p=0.04) remained significant. 36 new fatal and non-fatal new cardiovascular events occurred, 29 patient died. Cox proportional regression analysis showed that adiponectin below or above a ROC-derived cut-off of 27.33μg/mL significantly influenced event-free survival: hazard ratio (HR) 2.48, 95% confidence interval (CI) (1.09-5.66), p=0.031 along with fasting glucose HR 1.01, 95%CI(1.00-1.02), p=0.01 and history of cardiovascular events at inclusion HR 3.16, 95%CI(1.36-7.32), p=0.007. In multivariate analysis baseline adiponectin HR 5.02, 95%CI(0.98-25.06), p=0.05 and glycemia HR 1.01, 95%CI(1.00-1.02), p=0.01 influenced event-free survival. Adiponectin also predicted cardiovascular events in patients without cardiovascular disease at inclusion but was not associated to overall mortality.
  
  
  CONCLUSIONS
  In diabetes dialysis patients low adiponectin favors occurrence of atherosclerosis related cardiovascular events.
authors.affiliation: University of Medicine and Pharmacy "Iuliu Hatieganu" Cluj-Napoca, Department of Nephrology, 3-5 Clinicilor street, 400006 Cluj Napoca, Romania.
authors.forename: I M
authors.initials: IM
authors.lastname: Kacso
authors.affiliation: University of Medicine and Pharmacy "Iuliu Hatieganu" Cluj-Napoca, Department of Nephrology, 3-5 Clinicilor street, 400006 Cluj Napoca, Romania. Electronic address: alinalen@yahoo.com.
authors.forename: A R
authors.initials: AR
authors.lastname: Potra
authors.affiliation: University of Medicine and Pharmacy "Iuliu Hatieganu" Cluj-Napoca, Department of Informatics and Biostatistics, 6 Pasteur street, 400349 Cluj Napoca, Romania.
authors.forename: C I
authors.initials: CI
authors.lastname: Bondor
authors.affiliation: University of Medicine and Pharmacy "Iuliu Hatieganu" Cluj-Napoca, Department of Nephrology, 3-5 Clinicilor street, 400006 Cluj Napoca, Romania.
authors.forename: D
authors.initials: D
authors.lastname: Moldovan
authors.affiliation: University of Medicine and Pharmacy "Iuliu Hatieganu" Cluj-Napoca, Department of Nephrology, 3-5 Clinicilor street, 400006 Cluj Napoca, Romania.
authors.forename: C
authors.initials: C
authors.lastname: Rusu
authors.affiliation: NephroCare Dialysis Center Cluj, Ana Aslan street 40, 400495 Cluj-Napoca, Romania.
authors.forename: I M
authors.initials: IM
authors.lastname: Patiu
authors.affiliation: NephroCare Dialysis Center Cluj, Ana Aslan street 40, 400495 Cluj-Napoca, Romania.
authors.forename: S
authors.initials: S
authors.lastname: Racasan
authors.affiliation: NephroCare Dialysis Center Cluj, Ana Aslan street 40, 400495 Cluj-Napoca, Romania.
authors.forename: R
authors.initials: R
authors.lastname: Orasan
authors.affiliation: University of Medicine and Pharmacy "Iuliu Hatieganu" Cluj-Napoca, Department of Nephrology, 3-5 Clinicilor street, 400006 Cluj Napoca, Romania.
authors.forename: D
authors.initials: D
authors.lastname: Vladutiu
authors.affiliation: RenaClinic Cluj, Tache Ionescu street 72, 400473 Cluj-Napoca, Romania.
authors.forename: C
authors.initials: C
authors.lastname: Spanu
authors.affiliation: RenaClinic Cluj, Tache Ionescu street 72, 400473 Cluj-Napoca, Romania.
authors.forename: A
authors.initials: A
authors.lastname: Rusu
authors.affiliation: RenaClinic Cluj, Tache Ionescu street 72, 400473 Cluj-Napoca, Romania.
authors.forename: C
authors.initials: C
authors.lastname: Nita
authors.affiliation: Nefromed Dialysis Center Alba Iulia, 12 Turnatoriei street, 510185 Alba Iulia, Romania.
authors.forename: R
authors.initials: R
authors.lastname: Moldovan
authors.affiliation: Nefromed Dialysis Center Alba Iulia, 12 Turnatoriei street, 510185 Alba Iulia, Romania.
authors.forename: B
authors.initials: B
authors.lastname: Ghigolea
authors.affiliation: University of Medicine and Pharmacy "Iuliu Hatieganu" Cluj-Napoca, Department of Oncology, 34-36 Republicii street, 400115 Cluj-Napoca, Romania.
authors.forename: G
authors.initials: G
authors.lastname: Kacso
mesh_terms: D052242:Adiponectin / Q000097:blood*; D050197:Atherosclerosis / Q000097:blood; D002318:Cardiovascular Diseases / Q000097:blood / Q000175:diagnosis*; D015331:Cohort Studies; D003920:Diabetes Mellitus / Q000097:blood*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012044:Regression Analysis; D006435:Renal Dialysis; D016896:Treatment Outcome
chemical_list: C499918:ADIPOQ protein, human; D052242:Adiponectin
keywords: Adiponectin; Atherosclerosis; Cardiovascular events; Diabetes; Hemodialysis; Inflammation