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Adiponectin Is Inversely Associated with Renal Function in Type 1 Diabetic Patients

Departments of Clinical Chemistry (C.G.S.) and Internal Medicine VU University Medical Center (M.T.S., C.D.A.S.) and Institute for Cardiovascular Research (C.G.S., M.T.S., C.D.A.S.), Vrije Universiteit, 1007 MB Amsterdam, The Netherlands; International Centre for Circulatory Health and National Heart and Lung Institute (N.C.), Imperial College London, London W2 IPG, United Kingdom; and Department of Epidemiology and Public-Health (J.H.F.), Royal Free and University College London Medical School, London WC1E 6BT, United Kingdom

Address all correspondence and requests for reprints to: Casper G. Schalkwijk, Department of Internal Medicine, University Hospital Maastricht, P Debyelaan 25, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands. E-mail: C.Schalkwijk{at}intmed.unimaas.nl.

Objective: Adipose tissue is a source of several adipocytokines that may contribute to vascular complications. We examined the relation of adiponectin with several cardiovascular risk factors and with micro- and macrovascular outcomes in type 1 diabetic patients.

Design: Cross-sectional data on 543 type 1 diabetic patients from the EURODIAB Prospective Complications Study were analyzed. We determined adiponectin, TNF-, IL-6, C-reactive protein, soluble vascular cell adhesion molecule (sVCAM-1), and sE-selectin by ELISA.

Results: We found that adiponectin was negatively correlated with body mass index, waist to hip ratio, insulin, and fasting triglyceride, and positively with high-density lipoprotein, low-density lipoprotein, and total cholesterol, TNF-, and sVCAM-1, but was not related to C-reactive protein, IL-6, and sE-selectin. Surprisingly, significantly raised concentrations of adiponectin were found with albuminuria, retinopathy, and cardiovascular diseases (for all, P < 0.0001). Adiponectin levels were inversely associated with glomerular filtration rate (GFR) (P < 0.0001). Multivariate regression models showed that the associations of adiponectin with albuminuria and GFR were independent of established risk factors. The association between adiponectin and albuminuria was attenuated by GFR, whereas the association of adiponectin with retinopathy and cardiovascular disease disappeared after adjustments for established risk factors. The association of adiponectin with sVCAM-1 was independent of established risk factors.

Conclusion: We conclude that in type 1 diabetic patients, adiponectin is associated with impaired renal function. Adiponectin may be enhanced in type 1 diabetic patients as a physiological counterregulatory response to mitigate endothelial damage and vascular damage.

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