Association of adiponectin with peripheral arterial disease and mortality in nondiabetic hemodialysis patients: Long-term follow-up data of 7 years

Abstract

Background: The relationships between adiponectin and clinical outcomes in hemodialysis (HD) patients remain highly controversial. Meanwhile, the association between adiponectin and the peripheral artery disease (PAD) has not been well studied in HD patients without diabetic mellitus. Materials and Methods: The ankle-brachial index was measured in HD patients. Adiponectin levels in 105 HD patients were measured by Enzyme-Linked Immunosorbant Assay. Results: 105 HD patients were enrolled;14 (13%) patients had PAD. Using receiver-operating-characteristic (ROC) curve analysis for PAD, adiponectin (area under the curve [AUC] 0.935, 95% confidence interval [CI]: 0.848–0.981, P < 0.001) showed significantly positive predictive value. During follow-up (mean 63 ± 30 months), 34 deaths (32%) occurred. Kaplan–Meier analysis found those patients lower median adiponectin had a significantly poor outcome (P < 0.05), and Cox analysis further confirmed that adiponectin was an independent predictor of overall mortality (hazard ratio [HR], 0.832, 95% CI: 0.696–0.995, P < 0.05). The ROC curve of overall mortality showed that the AUC of adiponectin was 0.719 (95% CI: 0.586–0.813, P < 0.05). In HD patients with PAD, the univariate analysis showed that adiponectin (HR, 0.649, 95% CI: 0.527–0.800, P < 0.001) was also associated with overall mortality. Conclusion: Decreasing levels of adiponectin were associated with a significant increase in the risk of PAD in HD patients without diabetic mellitus.Furthermore, as the results of our observation period (maximum of 7 years) showed, adiponectin was a predictor of all-cause mortality in HD patients.

Key words: Adiponectin, ankle-brachial index, atherosclerosis, follow-up studies