Background: Cardiovascular diseases resulting from atherosclerotic complications are major causes of death in hemodialysis (HD) patients. Adiponectin (ADPN) is a recently discovered adipocyte-derived protein that appears to have protective role against atherosclerosis. HD patients have an excess accumulation of intra-abdominal fat mass in association with an atherogenic serum lipid profile despite low body mass index; however, the role of intra-abdominal fat mass in the progress of atherosclerosis remains to be clarified. Methods: We evaluated visceral (VFA) and subcutaneous fat areas (SFA) by computed tomography and measured the plasma ADPN in 47 HD patients. We also examined the relationship between visceral fat accumulation and plasma ADPN levels and clinical parameters related to atherosclerosis. Results: Plasma ADPN was 29.0 ± 12.5 µg/ml in HD patients (mean ± SD), two-fold higher than that in control subjects (14.0 ± 9.1 µg/ml). Plasma ADPN correlated significantly and negatively with visceral fat area (VFA) (r = –0.49, p < 0.001) and subcutaneous fat area (SFA) (r = –0.42, p < 0.01) in HD patients. Plasma ADPN also correlated significantly and positively with HDL-cholesterol (r = 0.45, p < 0.005) and significantly and negatively with atherosclerotic index (AI, r = –0.39, p < 0.01) and triglycerides (r = –0.32, p < 0.05) in HD patients. Multiple stepwise regression analysis identified VFA as a significant independent predictor of plasma ADPN concentration in HD patients. Conclusion: Our findings indicate that visceral fat is a major determinant of plasma ADPN level, suggesting that visceral fat accumulation might be closely associated with the progression of atherosclerotic vascular disease in HD patients.

Keywords:
Adiponectin, Visceral fat, Hemodialysis
1.
Reaven GM: Role of insulin resistance in human disease. Diabetes 1988;37:1595–1607.
2.
Kaplan NM: The deadly quartet, upper-body obesity, glucose intolerance, hypertriglyceridemia, and hypertension. Arch Intern Med 1989;149:1514–1520.
3.
Matsuzawa Y, Fujioka S, Tokunaga K, Tarui S: A novel classification: visceral fat obesity and subcutaneous fat obesity. Adv Obes Res 1987;92–96.
4.
Nakamura T, Tokunaga K, Shimomura I, et al: Contribution of visceral fat accumulation to development of coronary artery disease in non-obese men. Atherosclerosis 1994;107:239–246.
5.
Tarui S, Tokunaga K, Fujioka S, Matsuzawa Y: Visceral fat obesity: anthropological and pathophysiological aspects. Int J Obes 1991;15(suppl 2):1–8.
6.
Odamaki M, Furuya R, Ohkawa S, et al: Altered abdominal fat distribution and its association with the serum lipid profile in non-diabetic heamodialysis patients. Nephrol Dial Transplant 1999;14:2427–2432.
7.
Friedman JM: Obesity in the new millennium. Nature 2000;404:632–634.
8.
Hotamisligil GS: The role of TNF-alpha and TNF receptors in obesity and insulin resistance. J Intern Med 1999;245:621–625.
9.
Shimomura I, Funahashi T, Takahashi M, et al: Enhanced expression of PAI-1 in visceral fat: Possible contributor to vascular disease in obesity. Nat Med 1996;2:800–803.
10.
Steppan CM, Bailey ST, Bhat S, et al: The hormone resistin links obesity to diabetes. Nature 2001;409:307–312.
11.
Matsumoto S, Kishida K, Shimomura I, et al: Increased plasma HB-EGF associated with obesity and coronary artery disease. Biochem Biophys Res Commun 2002;292:781–786.
12.
Maeda K, Okubo K, Shimomura I, Funahashi T, Matsuzawa Y, Matsubara K: cDNA cloning and expression of a novel adipose specific collagen-like factor, apM1. Biochem Biophys Res Commun 1996;221:286–289.
13.
Hotta K, Funahashi T, Arita Y, et al: Plasma concentrations of a novel, adipose-specific protein, adiponectin, in type 2 diabetic patients. Arterioscler Thromb Vasc Biol 2000;20:1595–1599.
14.
Arita Y, Kihara S, Ouchi N, et al: Paradoxical decrease of an adipose-specific protein, adiponectin, in obesity. Biochem Biophys Res Commun 1999;257:79–93.
15.
Kumada M, Kihara S, Sumitsuji S, et al: Association of hypoadiponectinemia with coronary artery disease in men. Arterioscler Thromb Vasc Biol 2003;23:85–89.
16.
Stenvinkel P, Marchlewska A, Pecoits-Filho R, et al: Adiponectin in renal disease: Relationship to phenotype and genetic variation in the gene encoding adiponectin. Kidney Int 2004;65:274–281.
17.
Zoccali C, Mallalaci F, Tripepi G, et al: Adiponectin, metabolic risk factors, and cardiovascular event among patients with end-stage renal disease. J Am Soc Nephrol 2002;13:134–141.
18.
Cnop M, Havel PJ, Utzschneider KM, et al: Relationship of adiponectin to body fat distribution, insulin sensitivity and plasma lipoproteins: evidence for independent roles of age and sex. Diabetologia 2003;46:459–469.
19.
Yatagai T, Nagasaka S, Taniguchi A, et al: Hypoadiponectinemia is associated with visceral fat accumulation and insulin resistance in Japanese men with type 2 diabetes mellitus. Metabolism 2003;52:1274–1278.
20.
Yang WS, Lee WJ, Funahashi T, et al: Weight reduction increases plasma levels of an adipose-derived anti-inflammatory protein, adiponectin. J Clin Endocrinol Metab 2001;86:3815–3819.
21.
Yamauchi T, Kamon J, Waki H, et al: The mechanisms by which both heterozygous peroxisome proliferator-activated receptor gamma (PPARgamma) deficiency and PPARgamma agonist improve insulin resistance. J Biol Chem 2001;276:41245–41254.
22.
Halleux CM, Takahashi M, Delporte ML, et al: Secretion of adiponectin and regulation of apM1 gene expression in human visceral adipose tissue. Biochem Biophys Res Commun 2001;228:1102–1107.
23.
Yamauchi T, Kuno T, Takada H, et al: The impact of visceral fat on multiple risk factors and carotid atherosclerosis in chronic haemodialysis patients. Nephrol Dial Transplant 2003;18:1842–1847.
24.
Ouchi N, Kihara S, Arita Y, et al: Adiponectin, an adipocyte-derived plasma protein, inhibits endothelial NF-kappaB signaling through a cAMP-dependent pathway. Circulation 2000;102:1296–1301.
25.
Ouchi N, Kihara S, Arita Y, et al: Adipocyte-derived plasma protein, adiponectin, suppresses lipid accumulation and class A scavenger receptor expression in human monocyte-derived macrophages. Circulation 2001;103:1057–1063.
26.
Abbott KC, Glanton CW, Trespalacios FC, et al: Body mass index, dialysis modality, and survival: analysis of the United States Renal Data System Dialysis Morbidity and Mortality Wave II Study. Kidney Int 2004;65:597–605.
27.
Kaizu Y, Tsunega Y, Yoneyama T, et al: Overweight as another nutritional risk factor for the long-term survival of non-diabetic hemodialysis patients. Clin Nephrol 1998;50:44–50.
28.
Chudek J, Adamczak M, Karkoszka H, et al: Plasma adiponectin concentration before and after successful kidney transplantation. Transplant Proc 2003;35:2186–2189.
© 2006 S. Karger AG, Basel
2005
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.