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Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Chemerin: A biomarker for cardiovascular disease in diabetic chronic kidney disease patients
Farag E Salama1, Qasem A Anass1, Abdelnaem A Abdelrahman2
1Department of Internal Medicine, Zagazig University, Zagazig, Egypt.
Insights
Chemerin levels are elevated in chronic kidney disease (CKD) patients, particularly those with diabetes. Higher chemerin indicates increased atherosclerosis risk in CKD patients on conservative treatment or hemodialysis.
Area of Science:
- Nephrology
- Cardiology
- Endocrinology
Background:
- Cardiovascular disease (CVD) is a primary cause of death in chronic kidney disease (CKD) patients.
- Subclinical atherosclerosis, indicated by carotid intima-media thickness (CIMT) and arterial stiffness, is prevalent in CKD.
- Chemerin, an adipokine, links obesity and inflammation, potentially contributing to atherosclerosis in CKD.
Purpose of the Study:
- To investigate the relationship between serum chemerin levels and atherosclerosis (measured by CIMT).
- To assess chemerin's correlation with cardiovascular risk factors like interleukin-6 (IL-6) and insulin resistance (IR) in diabetic CKD patients.
- To compare chemerin levels in predialysis and hemodialysis (HD) CKD patients, considering diabetes status.
Main Methods:
- Serum chemerin and IL-6 levels were measured using ELISA in 58 CKD patients (predialysis and HD).
- Carotid intima-media thickness (CIMT) was assessed using high-resolution ultrasonography.
- Insulin resistance was evaluated using homeostasis model assessment (HOMA-IR).
Main Results:
- Serum chemerin levels increased progressively with declining glomerular filtration rate (control < predialysis < HD).
- Diabetic CKD patients exhibited significantly higher chemerin levels than nondiabetic CKD patients.
- Chemerin positively correlated with HOMA-IR, insulin, and C-reactive protein, and was an independent predictor of atherosclerosis in CKD.
Conclusions:
- Serum chemerin is a significant marker for atherosclerosis in CKD patients, irrespective of treatment modality (conservative or HD).
- Elevated chemerin levels are associated with diabetes, insulin resistance, and inflammation in CKD.
- Chemerin may play a crucial role in the pathogenesis of atherosclerosis and cardiovascular complications in CKD.
Abstract:
Cardiovascular disease is the leading cause of morbidity and mortality in patients with chronic kidney disease (CKD). The carotid intima-media thickness (CIMT) and arterial stiffness are useful markers of subclinical atherosclerosis and significantly correlate with various metabolic risk factors. Chemerin is one of the adipokines that may represent a link between obesity and inflammation and may be a potential candidate playing a role in the pathogenesis of atherosclerosis and cardiovascular complications. Therefore, we studied the relationship of chemerin levels with atherosclerosis as measured by CIMT in diabetic CKD patients, either predialysis or on hemodialysis (HD). In addition, we studied its correlation with other cardiovascular risk factors such as interleukin-6 (IL-6) and insulin resistance (IR). Fifty-eight patients were enrolled in the study; 23 patients with CKD (11 are diabetic) on conservative treatment and 35 (18 are diabetic) on maintenance HD. Serum concentrations of chemerin and IL-6 were determined by ELISA. All participants underwent measurements of CIMT by highresolution ultrasonography. A stepwise increase in serum chemerin levels was found depending on the glomerular filtration rate: 286.6 ± 10.02 ng/mL in the control group, 332.1 ± 21.54 ng/mL in the predialysis group, and 355.7 ± 20 ng/mL in the HD group. A significant rise of serum chemerin level was observed in diabetic CKD patients either on conservative therapy or on HD when compared with nondiabetic CKD patients. Moreover, there was a significant difference in serum levels of chemerin, IL-6, CIMT, serum insulin, and homeostasis model assessment of IR (HOMA-IR) between diabetic and nondiabetic patients in both groups. Chemerin showed a significant positive correlation with HOMA-IR, serum insulin, and C-reactive protein. In conclusion, serum chemerin level was found to be an independent predictive marker of the presence of atherosclerosis in patients with CKD either on conservative treatment or on HD.
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