Although the association between adipokines such as adiponectin, leptin, and body composition has been noted, whether they could predict the change of fat mass and lean body mass is unknown. We aimed to examine these associations in patients on peritoneal dialysis (PD) through a prospective cohort study.
Methods
Body composition (by dual-energy x-ray absorptiometry) including fat mass and lean body mass were examined at baseline and then at year 3. Serum leptin and adiponectin levels were measured. Demographic data, comorbidity, biochemical data, inflammation (high-sensitive C-reactive protein [hs-CRP]) and insulin resistance (homeostatic model assessment [HOMA-IR]) were also examined.
Results
At baseline, serum adiponectin levels were significantly inversely correlated with weight, lean body mass index (LBMI), fat mass index (FMI), lean body mass (LBM), and fat mass (FM) in 213 prevalent patients. At year 3, FMI, LBMI, FM, and the percentage of FM (FM%) increased while the percentage of LBM (LBM%) significantly decreased despite unchanged weight and LBM among the remaining 112 patients. After adjustment for demographic data, comorbidities, hs-CRP, HOMA-IR, and daily energy intake (DEI), serum adiponectin at baseline was not associated with increases in LBMI, FMI, and FM, but independently associated with an increase in FM% and a decrease in LBM%. The predictive effect of high-serum adiponectin level on mortality disappeared after adjusting for diabetes and cardiovascular disease. Serum leptin was not associated with any changes in body composition during the follow-up, nor with the mortality in this cohort.
Conclusions
A high adiponectin level could predict an increase in FM% and a decrease in LBM% during a 3-year follow-up in PD patients. Serum adiponectin could not independently predict mortality in PD patients.
IkizlerT.A., CanoN.J., FranchH., FouqueD., HimmelfarbJ., KalantarzadehK.Prevention and treatment of protein energy wasting in chronic kidney disease patients: a consensus statement by the International Society of Renal Nutrition and Metabolism.Kidney Int2013; 84: 1096–107.
2.
Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults.Executive summary of the third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III).JAMA2001; 285: 2486–97.
3.
SzetoC.C., KwanB.C., ChowK.M., LeungC.B., ChengM.S., LawM.C.Metabolic syndrome in peritoneal dialysis patients: choice of diagnostic criteria and prognostic implications.CJASN2014; 9: 779–87.
4.
DongJ., LiY.J., LuX.H., GanH.P., ZuoL., WangH.Y.Correlations of lean body mass with nutritional indicators and mortality in patients on peritoneal dialysis.Kidney Int2008; 73: 334–40.
5.
NooriN., KoppleJ.D., KovesdyC.P., FerozeU., SimJ.J., MuraliS.B.Mid-arm muscle circumference and quality of life and survival in maintenance hemodialysis patients.Clin J Am Soc Nephrol2010; 5: 2258–68.
6.
DongJ., LiY.J., XuR., YangZ.K., ZhengY.Novel equations for estimating lean body mass in peritoneal dialysis patients.Perit Dial Int2015; 35: 743–52.
7.
LiaoC.T., KaoT.W., ChouY.H., WuM.S., ChenY.M., ChuangH.F.Associations of metabolic syndrome and its components with cardiovascular outcomes among non-diabetic patients undergoing maintenance peritoneal dialysis.Nephrol Dial Transplant2011; 26: 4047–54.
8.
WuC.C., LiouH.H., SuP.F., ChangM.Y., WangH.H., ChenM.J.Abdominal obesity is the most significant metabolic syndrome component predictive of cardiovascular events in chronic hemodialysis patients.Nephrol Dial Transplant2011; 26: 3689–95.
9.
ChoiS.J., KimN.R., HongS.A., LeeW.B., ParkM.Y., KimJ.K.Changes in body fat mass in patients after starting peritoneal dialysis.Perit Dial Int2011; 31: 67–73.
10.
PellicanoR., StraussB.J., PolkinghorneK.R., KerrP.G.Longitudinal body composition changes due to dialysis.CJASN2011; 6: 1668–75.
11.
RincónB.A., BucaloL., AbadE.S., VegaM.A., BarracaN.D., YusteL.C.Fat tissue and inflammation in patients undergoing peritoneal dialysis.Clin Kidney J2016; 9: 374–80.
12.
LittleJ., PhillipsL., RussellL., GriffithsA., RussellG.I., DaviesS.J.Longitudinal lipid profiles on CAPD: their relationship to weight gain, comorbidity, and dialysis factors.JASN1998; 9: 1931–9.
13.
VasselaiP., KamimuraM.A., BazanelliA.P., PupimL.B., AvesaniC.M., da Mota RibeiroF.S.Factors associated with body-fat changes in prevalent peritoneal dialysis patients.J Renal Nutr2008; 18: 363–9.
14.
DongJ., IkizlerT.A.New insights into the role of anabolic interventions in dialysis patients with protein energy wasting.Curr Opin Nephrol Hypertens2009; 18: 469–75.
ParkJ.T., YooT.H., KimJ.K., OhH.J., KimS.J., DongE.Y.Leptin/adiponectin ratio is an independent predictor of mortality in nondiabetic peritoneal dialysis patients.Perit Dial Int2013; 33: 67–74.
17.
MałgorzewiczS., Aleksandrowicz-WronaE., OwczarzakA., Dębska-ŚlizieńA., RutkowskiB., Łysiak-SzydłowskaW.Adipokines and nutritional status for patients on maintenance hemodialysis.J Ren Nutr2010; 20: 303.
18.
SmithS.C.Jr., JacksonR., PearsonT.A., FusterV., YusufS., FaergemanO.Principles for national and regional guidelines on cardiovascular disease prevention: a scientific statement from the World Heart and Stroke Forum.Circulation2004; 109: 3112–21.
19.
MatthewsD.R., HoskerJ.P., RudenskiA.S., NaylorB.A., TreacherD.F., TurnerR.C.Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man.Diabetologia1985; 28: 412–9.
20.
WangA.Y., SandersonJ.E., SeaM.M., WangM., LamC.W., ChanI.H.Handgrip strength, but not other nutrition parameters, predicts circulatory congestion in peritoneal dialysis patients.Nephrol Dial Transpl2010; 25: 3372–9.
21.
PellicanoR., StraussB.J., PolkinghorneK.R., KerrP.G.Longitudinal body composition changes due to dialysis.CJASN2011; 6: 1668–75.
22.
VashisthaT.Dialysis modality and correction of uremic metabolic acidosis: relationship with all-cause and cause-specific mortality.Clin J Am Soc Nephrol2013; 8: 254–64.
23.
WangA.Y., SeaM.M., IpR., LawM.C., ChowK.M., LuiS.F.Independent effects of residual renal function and dialysis adequacy on actual dietary protein, calorie, and other nutrient intake in patients on continuous ambulatory peritoneal dialysis.JASN2001; 12: 2450–7.
24.
WangA.Y., SeaM.M., TangN., SandersonJ.E., LuiS.F., LiP.K.Resting energy expenditure and subsequent mortality risk in peritoneal dialysis patients.J Am Soc Nephrol2004; 15: 3134–43.
25.
RheeC.M., NguyenD.V., MoradiH., BrunelliS.M., DukkipatiR., JingJ.Association of adiponectin with body composition and mortality in hemodialysis patients.Am J Kidney Dis2015; 66: 313–21.
26.
StenvinkelP., MarchlewskaA., Pecoits FilhoR., ZhangZ., HoffC., HolmesC.Adiponectin in renal disease: relationship to phenotype and genetic variation in the gene encoding adiponectin.Kidney Int2004; 65: 274–81.
27.
ParkS.H., CarreroJ.J., LindholmB., StenvinkelP.Adiponectin in chronic kidney disease has an opposite impact on protein-energy wasting and cardiovascular risk: two sides of the same coin.Clin Nephrol2009; 72: 87–96.
28.
KaysenG.A., KotankoP., ZhuF., SarkarS.R., HeymsfieldS.B., KuhlmannM.K.Relationship between adiposity and cardiovascular risk factors in prevalent hemodialysis patients.J Renal Nutr2009; 19: 357–64.
TungC.W., HsuY.C., ShihY.H., LinC.L.Association of adiponectin with high-sensitivity C-reactive protein and clinical outcomes in peritoneal dialysis patients: a 3.5-year follow-up study.PLOS One2015; 10: e141058.
YamauchiT., KamonJ., WakiH., TerauchiY., KubotaN., HaraK.The fat-derived hormone adiponectin reverses insulin resistance associated with both lipoatrophy and obesity.Nat Med2001; 7: 941–6.
33.
JiaT., CarreroJ.J., LindholmB., StenvinkelP.The complex role of adiponectin in chronic kidney disease.Biochimie2012; 94: 2150–6.
34.
StenvinkelP., LindholmB., LönnqvistF., KatzarskiK., HeimbürgerO.Increases in serum leptin levels during peritoneal dialysis are associated with inflammation and a decrease in lean body mass.J Am Soc Nephrol2000; 11: 1303–9.
35.
DegerS.M., SundellM.B., SiewE.D., EgbertP., EllisC.D., ShaF.Insulin resistance and protein metabolism in chronic hemodialysis patients.J Renal Nutr2013; 23: e59–e66.
36.
LeeS.W., ParkG.H., LeeS.W., SongJ.H., HongK.C., KimM.J.Insulin resistance and muscle wasting in non-diabetic end-stage renal disease patients.Nephrol Dial Transpl2007; 22: 2554–62.
37.
DongJ., YangZ.K., ChenY.Older age, higher body mass index and inflammation increase the risk for new-onset diabetes and impaired glucose tolerance in patients on peritoneal dialysis.Perit Dial Int2016; 36: 277–83.
38.
AlixP.M., GuebreegziabherF., SoulageC.O.Leptin as an uremic toxin: deleterious role of leptin in chronic kidney disease.Biochimie2014; 105: 12–21.
39.
MarkakiA., KyriazisJ., StylianouK., FragkiadakisG.A., PerakisK., MargiorisA.N.The role of serum magnesium and calcium on the association between adiponectin levels and all-cause mortality in end-stage renal disease patients.PLOS One2012; 7: e52350.
40.
DrechslerC., KraneV., WinklerK., DekkerF.W., WannerC.Changes in adiponectin and the risk of sudden death, stroke, myocardial infarction, and mortality in hemodialysis patients.Kidney Int2009; 76: 567–75.
41.
DíezJ.J., EstradaP., BajoM.A., Fernández-ReyesM.J., GrandeC., DelP.G.High stable serum adiponectin levels are associated with a better outcome in prevalent dialysis patients.Am J Nephrol2009; 30: 244–52.
42.
IgnacyW., ChudekJ., AdamczakM., FunahashiT., MatsuzawaY., KokotF.Reciprocal association of plasma adiponectin and serum C-reactive protein concentration in haemodialysis patients with end-stage kidney disease—a follow-up study.Nephron Clin Pract2005; 101: c18–24.
43.
ZoccaliC., MallamaciF., TripepiG., BenedettoF.A., CutrupiS., ParlongoS.Adiponectin, metabolic risk factors, and cardiovascular events among patients with end-stage renal disease.J Am Soc Nephrol2002; 13: 134–41.
44.
SvendsenO.L., HaarboJ., HassagerC., ChristiansenC.Accuracy of measurements of body composition by dual-energy x-ray absorptiometry in vivo.Am J Clin Nutr1993; 57: 605–8.
45.
KimJ., WangZ.M., HeymsfieldS.B., BaumgartnerR.N., GallagherD.Total-body skeletal muscle mass: estimation by a new dual-energy x-ray absorptiometry method.Am J Clin Nutr2002; 76: 378–83.
