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Adiponectin in Children with Chronic Kidney Disease: Role of Adiposity and Kidney Dysfunction

Mark Mitsnefes^*, Janis Kartal^*, Philip Khoury, and Stephen Daniels

Divisions of ^* Nephrology and Hypertension and Cardiology, Cincinnati Children’s Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio; and Department of Pediatrics, University of Colorado School of Medicine, The Children’s Hospital, Denver, Colorado

Address correspondence to: Dr. Mark Mitsnefes, Division of Nephrology and Hypertension, Cincinnati Children’s Hospital Medical Center, MLC 7022, 3333 Burnet Avenue, Cincinnati, OH 45229-3039. Phone: 513-636-4531; Fax: 513-636-7407; E-mail: mark.mitsnefes{at}cchmc.org

Low serum adiponectin is a known cardiovascular risk in adult chronic kidney disease (CKD). However, adiponectin concentrations and their relation with other cardiovascular risks have not been studied in children with preterminal CKD. Forty-four children and adolescents who were aged 6 to 21 yr and had stages 2 to 4 CKD had serum adipocytes, lipoproteins, markers of inflammation, homocysteine, and insulin levels determined cross-sectionally. There were 29 lean (body mass index [BMI] <85th percentile) and 15 nonlean (BMI 85th percentile) patients. Mean serum adiponectin level was 30.6 ± 14.1 µg/ml (range 7.1 to 67.8 µg/ml). A total of 83% of patients had elevated adiponectin level. Despite similar kidney function, lean patients had significantly higher adiponectin levels than nonlean patients (34.1 ± 13.4 µg/ml versus 23.6 ± 13.3 µg/ml; P = 0.02). In univariate analysis, serum adiponectin negatively correlated with age (r = –0.34, P = 0.02), BMI (r = –0.47, P = 0.001), leptin (r = –0.41, P = 0.006), GFR (r = –0.39, P = 0.02), and insulin (r = –0.36, P = 0.01) and positively correlated with ApoA2 (r = 0.30, P = 0.04); no significant associations were found with markers of inflammation or homocysteine. Multivariate stepwise analysis showed that GFR (ß = –0.008, P = 0.001), BMI (ß = –0.16, P = 0.015), and age (ß = –0.04, P = 0.018) independently predicted serum adiponectin levels. Separate analysis of lean patients showed no significant relations with age or BMI; only GFR independently predicted serum adiponectin level (ß = –0.01, P = 0.0008). It is concluded that serum adiponectin is elevated in children and adolescents with stages 2 to 4 CKD and that decreased kidney function is a major determinant of elevated adiponectin concentrations. Despite overall elevated adiponectin, overweight patients display lower serum adiponectin levels and might be at risk for future cardiovascular complications.

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