Serum adiponectin and protein-energy wasting in predialysis chronic kidney disease.
OBJECTIVE
Adiponectin (ADPN) has antiatherogenic, anti-inflammatory, and insulin-sensitizing effects. Serum ADPN levels are increased in patients with chronic kidney diseases (CKD), and higher ADPN is paradoxically a predictor of mortality in these patients. The aim of this study was to determine the association between serum ADPN levels and protein-energy wasting (PEW) in predialysis CKD.


METHODS
We examined serum ADPN concentrations and PEW in 1303 patients from the KNOW-CKD (KoreaN Cohort Study for Outcome in Patients With Chronic Kidney Disease) study. PEW was defined as the presence of three or more of the following four indicators: serum albumin <3.8 g/dL, body mass index <23 kg/m2, urine creatinine excretion (UCE) below the lower quartile, and daily dietary protein intake <0.6 g/kg. We analyzed the association between PEW and ADPN using a multivariate regression model after adjustment for socioeconomic factors, comorbidities, and laboratory findings.


RESULTS
Among 1303 predialysis CKD patients, 72 (5.5%) had PEW. In multivariate logistic regression analysis, higher ADPN level was associated with PEW (odds ratio, 1.04; 95% confidence interval [CI], 1.01-1.08 by 1 μg/mL ADPN). The highest ADPN quartile was associated with PEW in comparison with the lowest quartile (odds ratio, 10.54; 95% CI, 1.28-86.74). In multiple linear regression with PEW indicators, ADPN was more strongly associated with UCE (β = -2.21; 95% CI, -4.13 to -0.28; R2= 0.67).


CONCLUSIONS
High ADPN is independently associated with PEW. Among PEW indicators, serum ADPN is closely associated with UCE as an indirect measure of muscle mass.
Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.
Young Youl
YY
Hyun
Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea. Electronic address: Kyubeck.lee@samsung.com.
Kyu-Beck
KB
Lee
Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
Kook-Hwan
KH
Oh
Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.
Curie
C
Ahn
Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea.
Sue Kyung
SK
Park
Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
Dong Wan
DW
Chae
Department of Internal Medicine, Yonsei University Severance Hospital, Seoul, Korea.
Tae-Hyun
TH
Yoo
Department of Internal Medicine, Yonsei University Severance Hospital, Seoul, Korea.
Kyu Hun
KH
Cho
Department of Internal Medicine, The Catholic University of Korea, Seoul St. Mary Hospital, Seoul, Korea.
Yong-Soo
YS
Kim
Department of Internal Medicine, Eulji General Hospital, Seoul, Korea.
Young-Hwan
YH
Hwang
D052242:Adiponectin / Q000097:blood*; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood / Q000652:urine; D015331:Cohort Studies; D015897:Comorbidity; D003404:Creatinine / Q000652:urine; D003430:Cross-Sectional Studies; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007668:Kidney / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D011502:Protein-Energy Malnutrition / Q000453:epidemiology*; D051436:Renal Insufficiency, Chronic / Q000097:blood* / Q000453:epidemiology / Q000503:physiopathology / Q000652:urine; D056910:Republic of Korea / Q000453:epidemiology; D012307:Risk Factors; D012720:Severity of Illness Index; D015854:Up-Regulation
C499918:ADIPOQ protein, human; D052242:Adiponectin; D015415:Biomarkers; D003404:Creatinine
Adiponectin; Chronic kidney disease; Protein–energy wasting; Urine creatinine excretion