title: Adiponectin is associated with early diabetic kidney disease in adults with type 1 diabetes: A Coronary Artery Calcification in Type 1 Diabetes (CACTI) Study.
abstract: OBJECTIVE
  The associations between elevated adiponectin and end-stage renal disease are well recognized and thought to be at least partially explained by reduced renal clearance. Conversely, the relationship between adiponectin and early diabetic kidney disease (DKD) with preserved glomerular filtration rate (GFR), including rapid GFR decline and incident chronic kidney disease (CKD) is unclear. We hypothesized that elevated adiponectin would be associated with early DKD in adults with type 1 diabetes.
  
  
  METHODS
  Adults with type 1 diabetes (n=646 at baseline, n=525 at 6years) had adiponectin and renal function by estimated GFR (eGFR) by CKD-EPI creatinine and albumin-excretion rate (AER) evaluated at baseline and 6years. Linear and logistic models evaluated the associations of baseline adiponectin with AER, macroalbuminuria (AER ≥200μg/min), eGFR, CKD (<60mL/min/1.73m2) and rapid GFR decline (>3mL/min/1.73m2/year). Models adjusted for age, sex, duration, HbA1c, SBP, LDL-C and current smoking.
  
  
  RESULTS
  Compared to non-diabetics, adults with type 1 diabetes had significantly higher adiponectin, and the difference remained significant after adjusting for AER and/or eGFR (p<0.0001). Adiponectin at baseline was positively associated with rapid GFR decline (OR: 1.24, 95% CI 1.00-1.53), incident CKD (OR: 1.75, 1.14-2.70), and persistent macroalbuminuria and CKD (OR: 1.61, 1.10-2.36) over 6years in adjusted models. The associations also remained significant after further adjustments for CRP, estimated insulin sensitivity and ACEi/ARB therapy.
  
  
  CONCLUSIONS
  Adults with type 1 diabetes have higher adiponectin than their non-diabetic peers, and elevated adiponectin at baseline is independently associated with greater odds of developing early DKD over 6years.
authors.affiliation: Department of Pediatric Endocrinology, University of Colorado School of Medicine, Aurora, CO, United States; Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, CO, United States. Electronic address: Petter.Bjornstad@childrenscolorado.org.
authors.forename: Petter
authors.initials: P
authors.lastname: Bjornstad
authors.affiliation: Department of Pediatric Endocrinology, University of Colorado School of Medicine, Aurora, CO, United States; Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO.
authors.forename: Laura
authors.initials: L
authors.lastname: Pyle
authors.affiliation: Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, CO, United States; Department of Epidemiology, Colorado School of Public Health, Aurora, CO.
authors.forename: Gregory L
authors.initials: GL
authors.lastname: Kinney
authors.affiliation: Department of Pediatric Endocrinology, University of Colorado School of Medicine, Aurora, CO, United States; Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, CO, United States.
authors.forename: Marian
authors.initials: M
authors.lastname: Rewers
authors.affiliation: Department of Medicine, Division of Nephrology, University of Colorado School of Medicine, Aurora, CO, United States.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Johnson
authors.affiliation: Department of Pediatric Endocrinology, University of Colorado School of Medicine, Aurora, CO, United States; Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, CO, United States; Department of Medicine, Division of Nephrology, University of Colorado School of Medicine, Aurora, CO, United States.
authors.forename: David M
authors.initials: DM
authors.lastname: Maahs
authors.affiliation: Department of Pediatric Endocrinology, University of Colorado School of Medicine, Aurora, CO, United States; Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, CO, United States.
authors.forename: Janet K
authors.initials: JK
authors.lastname: Snell-Bergeon
mesh_terms: D052242:Adiponectin / Q000097:blood*; D000328:Adult; D000419:Albuminuria / Q000209:etiology; D015331:Cohort Studies; D003922:Diabetes Mellitus, Type 1 / Q000150:complications*; D003928:Diabetic Nephropathies / Q000097:blood* / Q000503:physiopathology; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D007668:Kidney / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D051437:Renal Insufficiency / Q000097:blood* / Q000150:complications / Q000503:physiopathology / Q000652:urine; D051436:Renal Insufficiency, Chronic / Q000097:blood / Q000150:complications / Q000503:physiopathology / Q000652:urine; D012720:Severity of Illness Index; D015854:Up-Regulation; D055815:Young Adult
chemical_list: C499918:ADIPOQ protein, human; D052242:Adiponectin
keywords: Adiponectin; CKD-EPI creatinine; Diabetic nephropathy; Glomerular filtration rate (GFR); Type 1 diabetes