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Increased serum adiponectin levels predicted progression to ESRD
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Increased serum adiponectin levels predicted the progression from overt diabetic nephropathy to end-stage renal disease in patients with type 1 diabetes.
Researchers from sites in Helsinki, Finland conducted a prospective follow-up study of 1,330 patients with type 1 diabetes over five years. Patients were divided into a group with normoalbuminuria (n=818), a group with microalbuminuria (n=216) and a group with macroalbuminuria (n=296).
Progression to the next albuminuria level or to end-stage renal disease occurred in 193 patients, according to the study. There was no difference between progressors and nonprogressors in adiponectin concentrations for patients with normoalbuminuria or microalbuminuria.
Progression to ESRD was associated with higher adiponectin in patients with macroalbuminuria for progressors (23.4 mg/L) and nonprogressors (16.0 mg/L) and in men (P<.001) and women (P<.001). Progression to ESRD was linked to other variables including systolic blood pressure, insulin dose and serum cholesterol, according to the study. – by Christen Haigh
Diabetes Care. 2008;31:1165-1169.
The adipocyte-derived cytokine, adiponectin, has insulin-sensitizing, anti-inflammatory and anti-atherosclerosis properties, among others. Thus increased circulating adiponectin levels are generally associated with a beneficial cardiometabolic profile, whereas decreased levels are found in conditions associated with increased risk of cardiovascular disease, such as hypertension, dyslipidemia, type 2 diabetes and obesity. The notable exception to this paradigm is end-stage kidney disease, where markedly elevated plasma adiponectin levels occur. It is unclear whether the hyperadiponectinemia is a cause, consequence or an epiphenomenon with regard to end-stage kidney disease. The present report by Saraheimo et al. suggests a predictive temporal relationship between rising adiponectin levels and progression from macroalbuminuria to end-stage kidney disease. Many prior reports have failed to show such a relationship, so the jury is still out. Also unclear is the wider cardiometabolic significance of uremic hyperadiponectinemia.
– Samuel E. Dagogo-Jack, MD, FRCP
Endocrine Today Editorial Board member