Adiponectin and protein-energy defi ciency in patients receiving programmed hemodialysis treatment, is there a relationship?

Protein-energy wasting (PEW) is an independent predictor of morbidity and mortality in hemodialysis (HD) patients. Among the dishormonal disorders associated with its development, adiponectin (ADPN), an adipokine with a positive effect on carbohydrate metabolism and skeletal muscle condition, is of particular interest. However, end-stage renal failure (ESRD) is char- acterized by markedly elevated plasma ADPN levels combined with increased risks of cardiovascular events, activation of chronic low-level inflammation, high incidence of BEN and sarcopenia. BACKGROUND : to evaluate the relationship between serum ADPN levels and BEN levels in patients receiving HD treatment. PATIENTS AND METHODS . 645 patients receiving HD treatment (300 men and 345 women) with an average age of 56.8±12.8 years were examined. All patients were treated with bicarbonate HD according to the standard scheme. The diagnosis of PEW was carried out in accordance with the ISRNM rec- ommendations. The level of ADPN in blood serum was determined using the commercial kit "Adiponectin – ELISA" (“Mediag- nost”, Germany). RESULTS . The prevalence of PEW was 24.9%, and no sex differences were found. There was no relationship with the age of patients, the relationship with the duration of HD is highly reliable, but its degree is low (Rs=0.184 p=0.0001). The average concentration of ADPN in the blood serum in men was 7.8±2.7 ng/ml, in women 10.6±3.3 ng/ml (p=0.0001), while in women, elevated serum ADPN levels were statistically significantly less common than in men (63.19% and 79.33%, respectively, χ2=27.533, p=0.006). In patients with elevated serum ADPN levels, statistically significantly lower values of the main indicators of nutritional status were detected. When conducting multiple stepwise regression, a mathematical model was obtained, according to which ADPN is positively correlated with the volume of adipose tissue and negatively with serum albu- min and skeletal muscle mass, which was associated with a 1.5-fold increase in the probability of developing BEN, determined by the ISRNM method (χ2=164.63, p=0.0001). The null statistical hypothesis of the absence of differences and connections was rejected at p<0.05. CONCLUSION . The increase in ADPN levels in our patients is probably due to a combination of several reasons: an increase in production with the development of obesity, a decrease in clearance with ESRD, and the development of peripheral ADPN receptor resistance. The paradoxical, at first glance, relationship between a high level of ADPN and BEN can be explained by an increase in its effects in the paraventricular, arcuate, and lateral nuclei of the hypothalamus due to activation of AdipoR1, which leads to a decrease in appetite and increased energy expenditure.