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Clinical importance of an elevated circulating chemerin level in incident dialysis patients
Tae Yamamoto1, Abdul Rashid Qureshi, Björn Anderstam
1Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden.
Insights
Elevated chemerin levels in dialysis patients correlate with inflammation and dyslipidemia but surprisingly predict improved survival. Further research is needed to understand this paradoxical association in chronic kidney disease (CKD).
Area of Science:
- Nephrology
- Endocrinology
- Metabolic Research
Background:
- Chemerin, an adipokine linked to metabolic health, is elevated in chronic kidney disease (CKD).
- Its association with clinical, nutritional, and biochemical markers in CKD patients requires elucidation.
Purpose of the Study:
- To investigate the relationship between circulating chemerin and various clinical and biochemical markers in CKD Stage 5 patients.
- To determine the association between chemerin levels and 5-year all-cause mortality in this cohort.
Main Methods:
- Fasting plasma samples from 252 incident dialysis patients were analyzed for serum chemerin using ELISA.
- Chemerin levels were correlated with clinical status, biomarkers (inflammation, glucose, lipids), and body composition.
- Survival data were collected over a 5-year follow-up period.
Main Results:
- Chemerin positively correlated with cholesterol, triglycerides, apolipoprotein B, hs-CRP, white blood cell count, insulin, and HOMA index.
- Negative correlations were observed with GFR, HDL cholesterol, and homocysteine.
- Higher chemerin levels were associated with a survival advantage in univariate and adjusted Cox models (excluding GFR).
Conclusions:
- In incident dialysis patients, elevated chemerin is linked to inflammation and dyslipidemia.
- Despite these associations, higher chemerin levels predict a survival advantage in CKD Stage 5 patients initiating dialysis.
Background:
Circulating chemerin, a novel adipokine linked to obesity, glucose tolerance and hyperlipidaemia, was recently reported to be increased in chronic kidney disease (CKD) patients. We explored possible links between chemerin and various clinical, nutritional and biochemical markers as well as its association with 5-year all-cause mortality.
Methods:
Fasting plasma samples were obtained from 252 CKD Stage 5 patients [median age 56 years, male 61%, glomerular filtration rate (GFR) 7 mL/min] enrolled at the initiation of dialysis. Serum chemerin was measured using commercial ELISA. Chemerin levels were related to clinical status and biomarkers of inflammation, glucose and lipid metabolism and body composition (body mass index and total and truncal fat mass by dual-energy X-ray absorptiometry). Survival, censored for transplantation, was recorded for a follow-up time of 5 years.
Results:
In univariate regression, circulating chemerin (119 ± 26 ng/mL) was positively correlated with cholesterol (ρ = 0.21; P = 0.001), triglycerides (ρ = 0.22; P = 0.0007), apolipoprotein B (ρ = 0.33; P < 0.0001), high-sensitivity C-reactive protein (ρ = 0.18; P = 0.006), white blood cell count (ρ = 0.23; P < 0.001), insulin (ρ = 0.18; P < 0.05) and homeostatic model assessment (HOMA) index (ρ = 0.17; P < 0.05), whereas we found a negative correlation with GFR (ρ = -0.28; P = 0.007), high-density lipoprotein cholesterol (ρ = -0.15; P < 0.05) and homocysteine (ρ = -0.25; P = 0.001). Moreover, a high chemerin predicted a better survival (log-rank χ(2) = 3.85; P < 0.05). Also, in a Cox model, adjustments for age, sex and CRP did not alter this finding (hazard ratio = 1.98 [95% confidence interval = 1.13-3.50], P = 0.01). However, adjusting for GFR made the model non-significant.
Conclusions:
We report that, in incident dialysis patients, an elevated chemerin is associated with a survival advantage despite its significant positive association with markers of inflammation and dyslipidaemia.
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