Adiponectin in renal disease:: Relationship to phenotype and genetic variation in the gene encoding adiponectin

Background. The prevalence of cardiovascular disease (CVD) and inflammation is high in patients with end- stage renal disease (ESRD). Adiponectin is an adipocytokine that may have significant anti- inflammatory and anti- atherosclerotic effects. Low adiponectin levels have previously been found in patients with high risk for CVD. Methods. In a cohort of 204 (62% males) ESRD patients aged 52 +/- 1 years the following parameters were studied: presence of CVD, body composition, plasma adiponectin (N = 107), cholesterol, triglycerides, HDL- cholesterol, serum leptin, high-sensitivity C- reactive protein (hs- CRP), urinary albumin excretion (UAE), and single- nucleotide polymorphisms (SNPs) in the apM1 gene at positions -11391, -11377, 45, and 276. Thirty-six age- (52 +/- 2 years) and gender- matched (64% males) healthy subjects served as control subjects. Results. Markedly (P < 0.0001) elevated median plasma adiponectin levels were observed in ESRD patients (22.2 mu g/ mL), especially type 1 diabetic patients (36.8 mu g/mL), compared to control subjects (12.2 mu g/ mL). Log plasma adiponectin correlated to visceral fat mass (R = -0.29; P < 0.01) and Log hsCRP (R = 0.26; P < 0.01). In a stepwise (forward followed by backward) multiple regression model only type- 1 diabetes (P < 0.001) and visceral fat mass (P < 0.05) were independently associated with plasma adiponectin levels. The adiponectin gene -11377 C/ C genotype was associated with a lower prevalence of CVD (25 vs. 42%) compared to the G/ C genotype. Conclusion. The present cross- sectional study demonstrates that, whereas genetic variations seem to have a minor impact on circulating adiponectin levels, lower visceral fat mass and type 1 diabetes mellitus are associated with elevated plasma adiponectin levels in ESRD patients. Furthermore, low levels of adiponectin are associated with inflammation in ESRD.