title: Association of Adiponectin with High-Sensitivity C-Reactive Protein and Clinical Outcomes in Peritoneal Dialysis Patients: A 3.5-Year Follow-Up Study.
abstract: BACKGROUND
  Adiponectin (ADPN), one of most abundant fat-derived biologically active substances, plays an important role in anti-atherosclerotic process. There are conflicting results about the impact of ADPN on cardiovascular (CV) outcomes and mortality, particularly in patients undergoing peritoneal dialysis (PD). Moreover, the relationship between ADPN and inflammatory mediators has been seldom explored in this population. Therefore, we examined the relationship between ADPN and longitudinal high-sensitivity C-reactive protein (hs-CRP) changes and investigated whether ADPN or hs-CRP levels could predict CV outcomes and mortality in prevalent PD patients after comprehensive adjustment of possible confounders.
  
  
  METHODS
  In this prospective cohort study, 78 PD patients were enrolled and followed from February 2009 to August 2012. During follow-up, CV events and all-cause mortality were recorded.
  
  
  RESULTS
  The mean baseline ADPN value was 29.46±18.01 μg/ml and duration of PD treatment was 37.76±36.96 months. In multiple linear regression analysis, plasma ADPN levels positively correlated with high-density lipoprotein and negatively associated with hs-CRP, body mass index, D4/D0 glucose, triglyceride, and duration of PD treatment. After stratified by genders, the inverse association between baseline ADPN and hs-CRP was more significant in the female group. The hs-CRP levels were followed up annually and remained significantly lower in the high ADPN group in the first 2 years. Patients were then stratified into two groups according to the median ADPN value (23.8 μg/ml). The results of Kaplan-Meier survival analysis demonstrated less CV events and better survival in high ADPN group. On multivariate Cox regression analysis, only ADPN level (HR: 0.93, 95% CI: 0.88-0.98, p = 0.02), age and history of CV diseases were independent risk factors for future CV events. Furthermore, hs-CRP (HR: 1.11, 95% CI:1.001-1.22, p = 0.04) was identified as independent predictor of all-cause mortality.
  
  
  CONCLUSIONS
  Serum hs-CRP levels were consistently lower in the high ADPN group during 2-year follow-up. We also demonstrated the importance of ADPN and hs-CRP in predicting CV events and all-cause mortality in PD population during 3.5-year follow-up.
authors.affiliation: Department of Nephrology, Chang Gung Memorial Hospital, Chiayi, Taiwan; Graduate Institute of Clinical Medical Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Kidney and Diabetic Complications Research Team (KDCRT), Chang Gung Memorial Hospital, Chiayi, Taiwan; Chronic Kidney Disease Center, Chang Gung Memorial Hospital, Chiayi, Taiwan.
authors.forename: Chun-Wu
authors.initials: CW
authors.lastname: Tung
authors.affiliation: Department of Nephrology, Chang Gung Memorial Hospital, Chiayi, Taiwan; Department of Kidney and Diabetic Complications Research Team (KDCRT), Chang Gung Memorial Hospital, Chiayi, Taiwan; Chronic Kidney Disease Center, Chang Gung Memorial Hospital, Chiayi, Taiwan.
authors.forename: Yung-Chien
authors.initials: YC
authors.lastname: Hsu
authors.affiliation: Department of Nephrology, Chang Gung Memorial Hospital, Chiayi, Taiwan; Department of Kidney and Diabetic Complications Research Team (KDCRT), Chang Gung Memorial Hospital, Chiayi, Taiwan; Chronic Kidney Disease Center, Chang Gung Memorial Hospital, Chiayi, Taiwan.
authors.forename: Ya-Hsueh
authors.initials: YH
authors.lastname: Shih
authors.affiliation: Department of Nephrology, Chang Gung Memorial Hospital, Chiayi, Taiwan; Department of Kidney and Diabetic Complications Research Team (KDCRT), Chang Gung Memorial Hospital, Chiayi, Taiwan; Chronic Kidney Disease Center, Chang Gung Memorial Hospital, Chiayi, Taiwan; School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan, Republic of China.
authors.forename: Chun-Liang
authors.initials: CL
authors.lastname: Lin
mesh_terms: D052242:Adiponectin / Q000097:blood*; D002097:C-Reactive Protein / Q000378:metabolism*; D002318:Cardiovascular Diseases / Q000097:blood* / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis; D011379:Prognosis
chemical_list: C499918:ADIPOQ protein, human; D052242:Adiponectin; D002097:C-Reactive Protein