DETERMINANTS OF PLASMA ADIPONECTIN LEVELS IN PATIENTS WITH TYPE 2 DIABETES MELLITUS AND MICROALBUMINURIA OR LOW GRADE PROTEINURIA

摘要

Background. Recent experimental data show that increased plasma adiponectin in chronic kidney disease could be a response to inflammation.Objective. To identify factors influencing adiponectinemia in patients with type 2 diabetes (T2DM) and microalbuminuria or low grade proteinuria.Design. 32 patients with urinary albumin excretion rate (UAER)> 30 mg/g creatinine but without significant proteinuria (< trace COMBUR) were included and compared to 59 normalbuminuric T2DM controls. History, anthropometric measurements, laboratory analysis, total plasma adiponectin were obtained.Results. In our patients with UAER of 273.51+-57.26 mg/g creatinine and estimated glomemlar filtration rate (eGFR) 64.92+-4.56 mL/min, in simple regression, adiponectinemia con-elates inversely to eGFR (p=0.02, r= -0.38), triglyceridemia (p=0.03, r=-0.37) and hemoglobin (Hb -p= 0.01, r=-0.45) and positively to HDL cholesterol (p=0.001,1-0.54) and UAER (p<0.0001, r=0.71); the two latter parameters remain significant in multiple regression. In controls, adiponectinemia correlates inversely to age (p=0.04, r=-0.26) and BMI (p=0.04, r=-0.24); these and UAER predict adiponectinemia in multiple regression. 11 patients have UAE superior to 300 mg/g creatinine and 21 are strictly microalbuminuric (mean UAER 653.16+-97.02 and 83.68+-10.28mg albumin/g creatinine respectively). In microalbuminuric patients serum C reactive protein (CRP) correlates positively (p=0.0008, r=0.68) and Hb negatively (p=0.04, r=-0.41) to adiponectinemia; in multiple regression adiponectinemia only depends on CRP. In proteinuric patients CRP and glycated Hb correlate to adiponectinemia in stepwise multiple regression.Conclusion. Adiponectinemia is mainly predicted by UAER in our cohort whereas it depends on age and BMI in normalbuminuric T2DM controls; in strictly microalbuminuric patients CRP is a major predictor of adiponectinemia.