Association between plasma adiponectin concentration and visceral fat accumulation in hemodialysis patients

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.

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.

Plasma ADPN was 29.0 +/- 12.5 microg/ml in HD patients (mean +/- SD), two-fold higher than that in control subjects (14.0 +/- 9.1 microg/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.

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.