Adiponectin in chronic kidney disease is related more to metabolic disturbances than to decline in renal function

Background. Adiponectin, a newly discovered collagen-like protein of the collectin family exclusively produced by adipocytes, possesses anti-inflammatory properties. Plasma adiponectin is associated with a decreased cardiovascular risk in non-renal patients, and is reduced in obesity and insulin-resistant states. Although reports show an increase in the adiponectin level in maintenance haemodialysis, peritoneal dialysis and end-stage renal disease, there is no documentation of adiponectin levels and regulation in the early stages of chronic kidney disease (CKD). Methods. We prospectively measured glomerular filtration rate (GFR) in 48 patients with CKD using inulin clearance. Fasting blood was drawn to determine insulin, leptin, adiponectin and C-reactive protein (CRP) levels. Body fat mass was calculated using skinfold thickness measurements. Results. The patients' mean GFR was 53.5 +/- 24.9 (SD) ml/min/1.73 m(2). Adiponectin was in the normal range in men (9.8 +/- 2.9mg/l) and women (16.6 +/- 5.0 mg/l) with CKD, being significantly higher in women than men (P<0.001). Serum leptin was above normal (10.4 +/- 10.7 mug/l), whereas serum insulin and CRP were within their normal ranges (3.5 +/- 3.3 muU/ml and 2.6 +/- 5.0 mg/l, respectively). In linear regression analysis, adiponectin was negatively correlated with GFR (P=0.02), fat mass (P=0.03) and body mass index (P=0.002), and strongly positively correlated with serum leptin (P=0.003). A positive relationship was also found between plasma adiponectin and the urinary albumin/creatinine ratio (P=0.007). No relationship was found between adiponectin and insulin or adiponectin and CRP. In multiple regression analysis, adiponectin was significantly positively correlated with leptin (P<0.0001), negatively with body mass index (P<0.0001) and only weakly with GFR (P = 0.04). Conclusions. Despite an adverse metabolic environment in chronic renal insufficiency, serum adiponectin increases in non-obese patients when renal function deteriorates. Adiponectin is only weakly affected by renal function per se, but appears influenced by proteinuria, and more significantly by body mass index and the change in serum leptin that accompanies decline in renal function.