Objective Protein-Energy malnutrition (PEM) and inflammation are common and overlapping conditions in hemodialysis patients which are associated with increased risk of morbidity and mortality. Adiponectin is an adipocytokine which is exclusively produced by adipose tissue. Few studies in hemodialysis patients have demonstrated that serum levels of adiponectin were significantly higher in malnourished patients compared to well-nourished ones. The aim of this study was to further elucidate the association between serum adiponectin levels and the nutritional–inflammation status of hemodialysis patients.
Design. Observational comparative study.
Setting and Subjects 80 patients on stable hemodialysis at Shiraz Nemazee Hospital for at least three months three times weekly without any acute illness. The patients were divided into two groups of well-nourished (n=23) and malnourished (n=57) based on their nutritional status.
Main outcome measure Serum levels of adiponectin, interleukin-6 (IL-6), albumin, cholesterol, triglyceride, high-sensitive C-reactive protein, urea, creatinine, transferrin, homocysteine, ferritin, parathyroid hormone, as well as body mass index, the subjective global assessment (SGA) score, and the malnutrition–inflammation score (MIS) were measured in all patients; these values were compared between well-nourished and malnourished patients. The correlations of these variables with serum levels of adiponectin were determined as well.
Results Except the serum levels of adiponectin and IL-6 which were significantly higher in the malnourished patients compared to the well-nourished ones (40.7 ± 29.3 ng/mL versus 26.35 ± 16.8 ng/mL, p = 0.037 and 58.95 ± 106.7 pg/mL versus 50.78±145.61 pg/mL, p= 0.029, respectively), no other statistically significant differences were found between these two groups. Furthermore, weak but statistically significant positive correlations were found between the serum levels of adiponectin and and SGA(r = 0.29 p= 0.008) and MIS(r = 0.28 p = 0.01); a statistically significant negative correlation with moderate strength was also found between serum levels of adiponectin and TG (r = -0.36 p= 0.001).
Conclusion The results of our study point to potential utility of serum adiponectin level as an indicator of nutritional–inflammation status in hemodialysis patients. Further studies are needed to clarify the role of adiponectin in pathogenesis of malnutrition and inflammation in hemodialysis patients.
Keywords Adipocytes, Cytokines, Dialysis, Diet, Nutrition Assessment, Uremia
Malnutrition-inflammation complex syndrome (MICS) is a common finding in hemodialysis patients which is associated with poor prognosis (1). Possible causes of MICS include comorbid illnesses, oxidative stress, nutrient loss through dialysis, hyporexia, uremic toxins, decreased clearance of inflammatory cytokines, volume overload, increased blood phosphate and dialysis-related...