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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

Kaplan-Meier analyses of cumulative probability of cardiovascular events among PD patients during the 3.5-year follow-up.Patients were divided into low and high adiponectin groups according to the median value (23.8 μg/ml).
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pone.0141058.g003: Kaplan-Meier analyses of cumulative probability of cardiovascular events among PD patients during the 3.5-year follow-up.Patients were divided into low and high adiponectin groups according to the median value (23.8 μg/ml).

Mentions: Kaplan-Meier plots were generated by stratifying the plasma ADPN concentration at the median value (23.8 μg/ml). Patients with higher ADPN values had less CV events (Log-rank test, x2 = 9.61, p = 0.002) (Fig 3) and better survival (Log-rank test, x2 = 3.82, p = 0.05) (Fig 4). Cox’s proportional hazard model was further applied to assess the independent predictors of CV events and all-cause mortality in our cohort. Factors affecting the development of CV events are listed in Table 4. Lower ADPN, higher hs-CRP levels, older age, history of CV diseases, lower diastolic blood pressure, lower serum albumin, BUN, creatinine, and lower phosphorus levels were associated with cardiac events during the 42-month follow-up. On multivariate Cox regression analysis, only ADPN level (hazard ratio (HR): 0.93, 95% CI: 0.88–0.98, p = 0.02), age (HR: 1.06, 95% CI: 1.01–1.12, p = 0.01) and history of CV diseases (HR: 4.06, 95% CI: 1.27–13.01, p = 0.02) were identified as independent risk factors for CV events during follow-up. Every 1 μg/mL increase of ADPN level was independently predictive of a 7% reduction of CV events.


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)

Kaplan-Meier analyses of cumulative probability of cardiovascular events among PD patients during the 3.5-year follow-up.Patients were divided into low and high adiponectin groups according to the median value (23.8 μg/ml).
© Copyright Policy
Related In: Results  -  Collection

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

pone.0141058.g003: Kaplan-Meier analyses of cumulative probability of cardiovascular events among PD patients during the 3.5-year follow-up.Patients were divided into low and high adiponectin groups according to the median value (23.8 μg/ml).
Mentions: Kaplan-Meier plots were generated by stratifying the plasma ADPN concentration at the median value (23.8 μg/ml). Patients with higher ADPN values had less CV events (Log-rank test, x2 = 9.61, p = 0.002) (Fig 3) and better survival (Log-rank test, x2 = 3.82, p = 0.05) (Fig 4). Cox’s proportional hazard model was further applied to assess the independent predictors of CV events and all-cause mortality in our cohort. Factors affecting the development of CV events are listed in Table 4. Lower ADPN, higher hs-CRP levels, older age, history of CV diseases, lower diastolic blood pressure, lower serum albumin, BUN, creatinine, and lower phosphorus levels were associated with cardiac events during the 42-month follow-up. On multivariate Cox regression analysis, only ADPN level (hazard ratio (HR): 0.93, 95% CI: 0.88–0.98, p = 0.02), age (HR: 1.06, 95% CI: 1.01–1.12, p = 0.01) and history of CV diseases (HR: 4.06, 95% CI: 1.27–13.01, p = 0.02) were identified as independent risk factors for CV events during follow-up. Every 1 μg/mL increase of ADPN level was independently predictive of a 7% reduction of CV events.

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