Serum adiponectin and progression of diabetic nephropathy in patients with type 1 diabetes

doi:10.2337/dc07-2306

Serum adiponectin and progression of diabetic nephropathy in patients with type 1 diabetes

M. Saraheimo, MD^1,,²,
C. Forsblom, MD, DMSC^1,,²,
L. Thorn, MD^1,,²,
J. Wadén, MD^1,,²,
M. Rosengård-Bärlund, MD^1,,²,
O. Heikkilä, MD^1,,²,
K. Hietala, MD¹,
D. Gordin, MD²,
J. Frystyk, MD, DMSC, PHD³,
A. Flyvbjerg, MD, DMSC³ and
P.-H. Groop, MD, DMSC (per-henrik.groop{at}helsinki.fi) on behalf of the FinnDiane Study Group^1,,²

¹Folkhälsan Institute of Genetics, Folkhälsan Research Center, Biomedicum Helsinki
²Division of Nephrology, Department of Medicine, Helsinki University Central Hospital, Finland
³Medical Department M (Diabetes and Endocrinology) and the Medical Research Laboratories, Clinical Institute, Aarhus University Hospital, Denmark

Abstract

Objective: To elucidate whether serum adiponectin is associated with progression of diabetic nephropathy in type 1 diabetic patients.

Research Design And Methods: A prospective follow-up study, a part of the nationwide Finnish Diabetic Nephropathy Study. 1330 type 1 diabetic patients were followed for 5.0±2.2 years. Patients were divided at baseline into three groups according to their urinary albumin excretion rate (AER) in three consecutive overnight or 24 hour urine collections: 818 patients with normoalbuminuria [NA](AER < 20 ug/min), 216 with microalbuminuria [mi](20 ug/min < AER< 200ug/min) and 296 with macroalbuminuria [MA](AER > 200ug/min). Progression of albuminuria was the main outcome. Adiponectin was measured by a time-resolved immmunofluorometric assay, and the values were log-transformed and adjusted for age, BMI and sex before analysis.

Results: 193 patients progressed either to the next albuminuria level or end-stage renal disease (ESRD). No difference in adiponectin concentrations was observed between progressors and non-progressors in NA or MI patients. In the MA patients, progression to ESRD was associated with higher adiponectin in the entire group (23.4 ±17.1 vs. 16.0±8.5 mg/l, P<0.001) and in men (P<0.001) and women (P<0.001) separately. Progression to ESRD was also associated with systolic blood pressure (SBP), insulin dose, HbA_1c, S-cholesterol, S-triglycerides, AER and estimated glomerular filtration rate (eGFR). When these covariates were inserted in a Cox regression analysis, HbA_1c, triglycerides, eGFR and adiponectin were significantly associated with progression from macroalbuminuria.

Conclusions: Increased serum adiponectin levels predict the progression from macroalbuminuria to ESRD in type 1 diabetic patients.