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비당뇨병성 말기신부전 환자에서 심혈관질환 발생의 예측 인자로서 아디포넥틴의 유용성

Serum Adiponectin as a Predictor for Cardiovascular Outcomes in Non-Diabetic End-Stage Renal Disease Patients

대한신장학회지
2010년 29권 4호 p.465 ~ p.473
안혜림 ( An Hye-Rim ) - 연세대학교 의과대학 내과학교실

문성진 ( Moon Sung-Jin ) - 연세대학교 의과대학 내과학교실
박형천 ( Park Hyeong-Cheon ) - 연세대학교 의과대학 내과학교실
이용규 ( Lee Yong-Kyu ) - 연세대학교 의과대학 내과학교실
김좌경 ( Kim Jwa-Kyung ) - 연세대학교 의과대학 강남세브란스병원 내과
김범석 ( Kim Beom-Seok ) - 연세대학교 의과대학 내과학교실
김형종 ( Kim Hyung-Jong ) - CHA의과학대학교 내과학교실
한대석 ( Han Dae-Suk ) - 연세대학교 의과대학 내과학교실
하성규 ( Ha Sung-Kyu ) - 연세대학교 의과대학 내과학교실

Abstract

Purpose: Adiponectin (ADPN) has been known to protect against cardiovascular disease (CVD) in metabolic syndrome with normal renal function for its anti-inflammatory and anti-atherogenic property. However, it is still unclear whether ADPN is associated with cardiovascular outcomes in end-stage renal disease (ESRD) patients.

Methods: This study included 80 non-diabetic ESRD patients [mean age, 52.8±13.7 years; dialysis duration, 67.1±52.0 months; hemodialysis (HD), 35 pts; peritoneal dialysis (PD), 45 pts] who survived for more than 3 months after the start of dialysis, and serum ADPN levels were measured at the beginning of the study. We conducted a longitudinal follow-up to evaluate the association of serum ADPN level with cardiovascular outcomes for 29.3±6.7 months.

Results: ADPN was inversely correlated with fasting serum insulin (r=-0.309, p=0.006) and HOMA-IR (r=-0.321, p=0.004) in ESRD patients. In a multiple linear regression analysis adjusted for age, gender, waist to hip ratio (WHR), and HDL-cholesterol, HOMA-IR (β=-0.880, p=0.041) was an independent factor associated with serum ADPN level. Kaplan-Meier analysis revealed that patients with higher ADPN levels (≥15.8 μg/mL) had a significantly higher survival rate compared with lowers (<15.8 μg/mL) (p=0.032). Cox proportional hazard model adjusted for age, WHR, creatinine, CRP, and previous CVD history revealed that serum ADPN level (HR, 0.899; 95% CI, 0.818-0.987; p=0.026) was an independent determinant of cardiovascular outcomes.

Conclusion: These findings suggest that lower ADPN levels independently predict cardiovascular events in non-diabetic ESRD patients.

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