Effect of Different Hemodialysis Modality on Adiponectin,Vascular Function and Clinical Prognosis
Effect of Different Hemodialysis Modality on Adiponectin,Vascular Function and Clinical Prognosis
Adiponectin, an adipose tissue derived protein, with anti-inflammatory properties that is
 secreted from adipose tissue, is associated with insulin resistance. It has been shown to be
 a predictor of cardiovascular events in both the general population and patients undergoing
 hemodialysis. Adiponectin levels were inversely related to body mass index values, plasma
 leptin levels, insulin levels, serum triglyceride levels, and homeostatic model assessment
 index values. In addition to it's ability in increasing insulin sensitivity, adiponectin was
 demonstrated to have anti-inflammatory and anti-atherogenic properties. In patients with
 ESRD, renal replacement method was either peritoneal dialysis or HD. High efficient dialysis
 methods such as high flux HD and HDF had been used more and more popularly. High flux HD and
 HDF have the advantages in middle to large molecule removal, and better hemodynamic
 stability. Better clinical prognosis has been shown in patients undergoing high flux HD or
 HDF. Although studies have demonstrated that the plasma adiponectin levels were elevated in
 patients receiving HD, whether different dialysis modality will interfere the plasma
 adiponectin levels and patients' prognosis remain unknown. The current project is planned to
 investigate the effects of different HD modality on the plasma adiponectin levels and its
 correlation other serum inflammatory markers and vascular function. Patients' long term
 prognosis will also be assessed in the present study.
Adiponectin, a cytokine with anti-inflammatory properties that is secreted from adipose
 tissue, is associated with insulin resistance (Horm Metab Res 34:469-474, 2002). The plasma
 adiponectin level has been reported to be decreased in some insulin-resistant states, such as
 obesity and type 2 diabetes (Biochem Biophys Res Commun 257:79-83, 1999), and coronary artery
 disease (CAD). However, it is shown to increase in chronic renal failure and type 1 diabetes.
 (European Journal of Endocrinology 148;293-300, 2003). Plasma adiponectin levels were
 inversely related to body mass index values, plasma leptin levels, insulin levels, serum
 triglyceride levels, and homeostatic model assessment index values (J Am Soc Nephrol
 13:134-141, 2002, Clin Sci 103:137-142, 2002, Arterioscler Thromb Vasc Biol 20:1595-1599,
 2000, Diabetes 52:942-947, 2003). In addition to it's ability in increasing insulin
 sensitivity, adiponectin was demonstrated to have anti-inflammatory and anti-atherogenic
 properties. (European Journal of Endocrinology 148;293-300, 2003, J Hypertens 18:1207-1213,
 2000). It is also associated with vascular function independent of insulin sensitivity
 (Diabetes Care 27:739-745, 2004). In patients with ESRD, CAD remained the leading cause of
 death (Kidney Int 62:1417-1422, 2002) regardless of different renal replacement methods
 (peritoneal dialysis or HD) and the modality it uses. In recent years, with the development
 of high flux HD and HDF, the dialyzer has gained much progress in its efficiency. High flux
 HD and HDF have the advantages in middle to large molecule removal and better hemodynamic
 stability (Kidney Int. 66:355-66, 2004). Adiponectin, a large molecule (30kd), was not
 removed readily by conventional HD (Am J Kidney Dis 43:1047-1055, 2004), but it might be
 removed by high flux and HDF.

 Due to undialyzable characteristic and decreased excretion from impaired renal function (Am J
 Kidney Dis 43:1047-1055, 2004, Circulation 100:2473-2476, 1999), adiponectin level is
 elevated in patients receiving HD and PD. Adiponectin has been shown to be a predictor of
 cardiovascular events in both the general population and patients undergoing HD (J Am Soc
 Nephrol 13:134-141, 2002) or PD (Am J Kidney Dis 43:1047-1055, 2004). Weather the elevation
 of adiponectin level is a protective factor of cardiovascular risk or just a reactor from
 inflammatory condition remains unknown. This project was aimed to study the removal
 efficiency of adiponectin in high flux HD and HDF and also the consequence of long term
 prognosis. Besides, other metabolic and inflammatory markers such as CRP, homocystine,
 insulin, interleukin group will be measured. Adiponectin, an adipose tissue derived protein,
 with anti-inflammatory properties that is secreted from adipose tissue, is associated with
 insulin resistance. So this project was aimed to study:

 1. The removal efficiency of adiponectin in different hemodialysis modality.

 2. To figure out the role of adiponectin in ESRD patients: a protective or an inflammation
 marker.

 3. Patients' long term prognosis will be analyzed.

 4. Other metabolic and inflammatory markers such as CRP, homocystine, insulin, interleukin
 group and their relationship with adiponectin will be investigated.

 5. Vascular function will be assessed and its correlation with adiponectin levels will be
 studied.
Inclusion Criteria:

 Clinical diagnosis on ESRD under regular maintenance hemodialysis, no active infection, no
 allergy to chosen AK, informed consent acquired

 Exclusion Criteria:

 Not ESRD, temporary HD, active infection, during admission, allergy to chosen AK, without
 informed consent