Association of Adiponectin with Body Composition and Mortality in Hemodialysis Patients

TY - JOUR

T1 - Association of Adiponectin with Body Composition and Mortality in Hemodialysis Patients

AU - Rhee, Connie M.

AU - Nguyen, Danh V.

AU - Moradi, Hamid

AU - Brunelli, Steven M.

AU - Dukkipati, Ramanath

AU - Jing, Jennie

AU - Nakata, Tracy

AU - Kovesdy, Csaba P.

AU - Brent, Gregory A.

AU - Kalantar-Zadeh, Kamyar

PY - 2015/8/1

Y1 - 2015/8/1

N2 - 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. Study Design Prospective cohort study. Settings & Participants 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). Predictor Serum adiponectin concentration in tertiles (tertiles 1, 2, and 3 defined as ≤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). Outcomes 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). Limitations 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.

AB - 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. Study Design Prospective cohort study. Settings & Participants 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). Predictor Serum adiponectin concentration in tertiles (tertiles 1, 2, and 3 defined as ≤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). Outcomes 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). Limitations 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.

KW - anthropometry

KW - body composition

KW - body fat

KW - body mass index (BMI)

KW - cardiovascular disease (CVD)

KW - end-stage renal disease

KW - hemodialysis

KW - Index Words Adiponectin

KW - lipids

KW - MADRAD (Malnutrition, Diet, and Racial Disparities in Chronic Kidney Disease) study

KW - mortality

KW - renal replacement therapy (RRT)

UR - http://www.scopus.com/inward/record.url?scp=84937966128&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84937966128&partnerID=8YFLogxK

U2 - 10.1053/j.ajkd.2015.02.325

DO - 10.1053/j.ajkd.2015.02.325

M3 - Article

C2 - 25824125

AN - SCOPUS:84937966128

VL - 66

SP - 313

EP - 321

JO - American Journal of Kidney Diseases

JF - American Journal of Kidney Diseases

SN - 0272-6386

IS - 2

ER -