Limits...
Association of Adiponectin with High-Sensitivity C-Reactive Protein and Clinical Outcomes in Peritoneal Dialysis Patients: A 3.5-Year Follow-Up Study.

Tung CW, Hsu YC, Shih YH, Lin CL - PLoS ONE (2015)

Bottom Line: There are conflicting results about the impact of ADPN on cardiovascular (CV) outcomes and mortality, particularly in patients undergoing peritoneal dialysis (PD).The results of Kaplan-Meier survival analysis demonstrated less CV events and better survival in high ADPN group.Serum hs-CRP levels were consistently lower in the high ADPN group during 2-year follow-up.

View Article: PubMed Central - PubMed

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.

ABSTRACT

Introduction: 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.

No MeSH data available.


Related in: MedlinePlus

(A) Comparisons of high-sensitivity C-reactive protein (hs-CRP) levels between high and low adiponectin (ADPN) groups at indicated time point; (B) Box plots of changes of hs-CRP (Δhs-CRP) between high and low ADPN groups at indicated time point.# represent statically significant (p< 0.05) when compared to low ADPN group respectively.
© Copyright Policy
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4608701&req=5

pone.0141058.g001: (A) Comparisons of high-sensitivity C-reactive protein (hs-CRP) levels between high and low adiponectin (ADPN) groups at indicated time point; (B) Box plots of changes of hs-CRP (Δhs-CRP) between high and low ADPN groups at indicated time point.# represent statically significant (p< 0.05) when compared to low ADPN group respectively.

Mentions: High-sensitivity CRP was checked at enrollment and followed annually. The hs-CRP level was significantly lower in the high ADPN group at baseline (2.88±3.24 vs. 5.24±5.08, p = 0.01), one-year follow up (2.71±2.02 vs. 5.77±5.91, p<0.01) and two years later (3.26±4.50 vs. 5.53±5.08, p = 0.01) (Fig 1A). Though there was no significant difference, the third-year hs-CRP tended to decrease among the high ADPN group (3.41±3.01 vs. 5.35±4.52, p = 0.12). The changes of hs-CRP between high and low ADPN groups were insignificant through the 3-year follow-up period (at one-year: -0.17±3.43 vs. 0.69±5.87, p = 0.43; at 2-year: 0.40±5.18 vs. 0.46±5.60, p = 0.39; and at 3-year: 0.42±4.18 vs. 0.94±5.83, p = 0.62, respectively) (Fig 1B) There was strong association between ADPN and hs-CRP initially (r = −0.412 (95% confidence interval (CI): −0.574, -0.223, p<0.01) (Fig 2A). Correlations remained statistically significant for the baseline ADPN and hs-CRP at one-year (r = −0.405, 95% CI: −0.622, -0.136, p< 0.01) and 2-year follow-up (r = −0.342, 95% CI: –0.525, -0.145, p< 0.01) (Fig 2B). The relationship between baseline ADPN and hs-CRP at 3-year later was less significant (r = −0.183, 95% CI: -0.448, 0.100, p = 0.19). There were similar expression values of hs-CRP among both genders during the 3-year follow-up period (S1 Table). Additionally, gender difference did not influence the inverse correlations between baseline ADPN and annually followed hs-CRP values (S2 Table).


Association of Adiponectin with High-Sensitivity C-Reactive Protein and Clinical Outcomes in Peritoneal Dialysis Patients: A 3.5-Year Follow-Up Study.

Tung CW, Hsu YC, Shih YH, Lin CL - PLoS ONE (2015)

(A) Comparisons of high-sensitivity C-reactive protein (hs-CRP) levels between high and low adiponectin (ADPN) groups at indicated time point; (B) Box plots of changes of hs-CRP (Δhs-CRP) between high and low ADPN groups at indicated time point.# represent statically significant (p< 0.05) when compared to low ADPN group respectively.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4608701&req=5

pone.0141058.g001: (A) Comparisons of high-sensitivity C-reactive protein (hs-CRP) levels between high and low adiponectin (ADPN) groups at indicated time point; (B) Box plots of changes of hs-CRP (Δhs-CRP) between high and low ADPN groups at indicated time point.# represent statically significant (p< 0.05) when compared to low ADPN group respectively.
Mentions: High-sensitivity CRP was checked at enrollment and followed annually. The hs-CRP level was significantly lower in the high ADPN group at baseline (2.88±3.24 vs. 5.24±5.08, p = 0.01), one-year follow up (2.71±2.02 vs. 5.77±5.91, p<0.01) and two years later (3.26±4.50 vs. 5.53±5.08, p = 0.01) (Fig 1A). Though there was no significant difference, the third-year hs-CRP tended to decrease among the high ADPN group (3.41±3.01 vs. 5.35±4.52, p = 0.12). The changes of hs-CRP between high and low ADPN groups were insignificant through the 3-year follow-up period (at one-year: -0.17±3.43 vs. 0.69±5.87, p = 0.43; at 2-year: 0.40±5.18 vs. 0.46±5.60, p = 0.39; and at 3-year: 0.42±4.18 vs. 0.94±5.83, p = 0.62, respectively) (Fig 1B) There was strong association between ADPN and hs-CRP initially (r = −0.412 (95% confidence interval (CI): −0.574, -0.223, p<0.01) (Fig 2A). Correlations remained statistically significant for the baseline ADPN and hs-CRP at one-year (r = −0.405, 95% CI: −0.622, -0.136, p< 0.01) and 2-year follow-up (r = −0.342, 95% CI: –0.525, -0.145, p< 0.01) (Fig 2B). The relationship between baseline ADPN and hs-CRP at 3-year later was less significant (r = −0.183, 95% CI: -0.448, 0.100, p = 0.19). There were similar expression values of hs-CRP among both genders during the 3-year follow-up period (S1 Table). Additionally, gender difference did not influence the inverse correlations between baseline ADPN and annually followed hs-CRP values (S2 Table).

Bottom Line: There are conflicting results about the impact of ADPN on cardiovascular (CV) outcomes and mortality, particularly in patients undergoing peritoneal dialysis (PD).The results of Kaplan-Meier survival analysis demonstrated less CV events and better survival in high ADPN group.Serum hs-CRP levels were consistently lower in the high ADPN group during 2-year follow-up.

View Article: PubMed Central - PubMed

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.

ABSTRACT

Introduction: 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.

No MeSH data available.


Related in: MedlinePlus