Determinants of serum high molecular weight (HMW) adiponectin levels in patients with coronary artery disease: associations with cardio-renal-anemia syndrome

Association of anemia with hyperadiponectinemia in oldest-old Japanese women who resided at home alone without wheelchair use

The association of anemia with hyperadiponectinemia (HAN) (≥ 20 μg/mL) was studied in 95 Japanese women aged 65-74 (young-old), 175 women aged 75-84 (old-old), and 51 women aged over 85 (oldest-old) who resided at home alone without wheelchair use. The prevalence of anemia was 21.5% overall and increased with aging stepwise (9.5, 22.9, and 39.2% in young-olds, old-olds, and oldest-olds, respectively, p < 0.001). Most of the anemia was normocytic and only one woman had hemoglobin < 10 g/dL. Old-olds with anemia had low serum iron, albumin, and cholesterol and a higher prevalence of renal insufficiency (30.0 versus 5.2%, p < 0.001). In contrast, these variables did not differ between anemic and non-anemic young-olds. oldest-olds with anemia had low serum iron and higher adiponectin concentrations (22.8 ± 9.8 vs. 16.0 ± 6.7 μg/mL, p = 0.005) and prevalence of HAN (60.0 vs. 19.4%, p = 0.006) and renal insufficiency (50.0 vs. 0%, p < 0.001). However, inflammatory markers did not differ between anemic and non-anemic oldest-olds. The prevalence of anemia was higher in oldest-olds with versus without HAN (66.7 vs. 24.2%, p = 0.006). In multivariable logistic regression analysis, anemia was associated with HAN (OR: 15.7, 95% CI 1.2-207, p = 0.03) in oldest-olds and with renal insufficiency (OR: 7.1, 95% CI 2.4-21.0, p < 0.001) in old-olds. In conclusion, the association of anemia with HAN was evident in oldest-old Japanese women, suggesting the anti-inflammatory properties of circulating adiponectin.

Impact of anemia requiring transfusion or erythropoiesis-stimulating agents on new-onset cardiovascular events and mortality after continuous renal replacement therapy

Anemia is common in critically ill patients undergoing continuous renal replacement therapy (CRRT). We investigated the impact of anemia requiring red blood cell (RBC) transfusion or erythropoiesis-stimulating agents (ESAs) on patient outcomes after hospital discharge in critically ill patients with acute kidney injury (AKI) requiring CRRT. In this retrospective cohort study using the Health Insurance Review and Assessment database of South Korea, 10,923 adult patients who received CRRT for 3 days or more between 2010 and 2019 and discharged alive were included. Anemia was defined as the need for RBC transfusion or ESAs. Outcomes included cardiovascular events (CVEs) and all-cause mortality after discharge. The anemia group showed a tendency to be older with more females and had more comorbidities compared to the control group. Anemia was not associated with an increased risk of CVEs (adjusted hazard ratio [aHR]: 1.05; 95% confidence interval [CI]: 0.85-1.29), but was associated with an increased risk of all-cause mortality (aHR: 1.41; 95% CI 1.30-1.53). For critically ill patients with AKI requiring CRRT, anemia, defined as requirement for RBC transfusion or ESAs, may increase the long-term risk of all-cause mortality.

Transcriptomics: A Step behind the Comprehension of the Polygenic Influence on Oxidative Stress, Immune Deregulation, and Mitochondrial Dysfunction in Chronic Kidney Disease

Chronic kidney disease (CKD) is an increasing and global health problem with a great economic burden for healthcare system. Therefore to slow down the progression of this condition is a main objective in nephrology. It has been extensively reported that microinflammation, immune system deregulation, and oxidative stress contribute to CKD progression. Additionally, dialysis worsens this clinical condition because of the contact of blood with bioincompatible dialytic devices. Numerous studies have shown the close link between immune system impairment and CKD but most have been performed using classical biomolecular strategies. These methodologies are limited in their ability to discover new elements and enable measuring the simultaneous influence of multiple factors. The “omics” techniques could overcome these gaps. For example, transcriptomics has revealed that mitochondria and inflammasome have a role in pathogenesis of CKD and are pivotal elements in the cellular alterations leading to systemic complications. We believe that a larger employment of this technique, together with other “omics” methodologies, could help clinicians to obtain new pathogenetic insights, novel diagnostic biomarkers, and therapeutic targets. Finally, transcriptomics could allow clinicians to personalize therapeutic strategies according to individual genetic background (nutrigenomic and pharmacogenomic). In this review, we analyzed the available transcriptomic studies involving CKD patients.

Comparison of Transradial and Transfemoral Approaches for Percutaneous Coronary Intervention in Patients With Acute Coronary Syndrome and Anemia

Anemia is an independent predictor of bleeding complications and poor clinical outcomes after percutaneous coronary intervention. Percutaneous coronary transradial intervention (TRI) is better than percutaneous coronary transfemoral intervention (TFI) in terms of reducing bleeding complications that can affect the prognosis. This study aims to investigate the clinical outcomes between TRI and TFI for patients with anemia. We analyzed periprocedure complications, in-hospital mortality, and major adverse cardiac events for one year in the Korean TRI registry from January 2013 to April 2014. Patients with chronic kidney disease for whom TFI is preferred were excluded. Anemia was defined as hemoglobin <13 g/dl for men and <12 g/dl for women. A total of 1,279 patients were finally enrolled. Of these, 348 patients had anemia. Among them, 253 patients (72.7%) underwent TRI and 95 patients (27.3%) underwent TFI. There were no significant differences of baseline demographic characteristics between the TRI and TFI groups, except for the incidence of dyslipidemia (TRI 23.7% vs TFI 12.6%, p = 0.023). Multivariate logistic regression analysis revealed lower incidence of composite severe bleeding complications (hazard ratio 0.34, 95% CI 0.12 to 0.99, p = 0.049) and lower incidence of in-hospital mortality than TFI group (hazard ratio 0.74, 95% CI 0.62 to 0.88, p = 0.042). In conclusion, this study suggests that the TRI for patients with anemia may be translated into better prognosis in terms of lower rates of bleeding complications and in-hospital mortality.

Protective effects of naringenin in cardiorenal syndrome

BACKGROUND

Cardiorenal syndrome is a complicated and bidirectional interrelationship between the heart and kidneys. Naringenin (NG) is a naturally occurring flavonoid possessing various biological and pharmacological properties.

MATERIALS AND METHODS

We tested whether NG could improve cardiac and renal function in a rat model of cardiorenal syndrome.

RESULTS

The results showed that NG-attenuated cardiac remodeling and cardiac dysfunction in rats with cardiorenal syndrome, as evidenced by decrease of left ventricle weight (LVW), increase of body weight (BW), decrease of LVW/BW, decrease of concentrations of serum creatinine, blood urea nitrogen, type-B natriuretic peptide, aldosterone, angiotensin (Ang) II, C-reactive protein, and urine protein, increase of left ventricular systolic pressure and falling rates of left ventricular pressure (dp/dtmax), and decrease of left ventricular diastolic pressure, left ventricular end-diastolic pressure, and -dp/dtmax. NG significantly inhibited the increase of lipid profiles including low-density lipoprotein, TC, and TG in rats. In addition, NG significantly inhibited the increase of cardiac expression of IL-1β, IL-6, and interferon γ. Moreover, NG decreased malonaldehyde level, increased superoxide dismutase activity and glutathione content in rats, and increased the expression of nuclear factor erythroid 2-related factor 2 (Nrf2) and catalytic subunit of γ-glutamylcysteine ligase (GCLc) in rats and Ang II-treated cardiac fibroblasts. Inhibition of Nrf2 and glutathione synthesis significantly suppressed NG-induced decrease of ROS level. Inhibition of Nrf2 markedly suppressed NG-induced increase of GCLc expression in Ang II-treated cardiac fibroblasts.

CONCLUSIONS

The data provide novel options for therapy of patients and new insights into the cardioprotective effects of NG in cardiorenal syndrome.

Predicting the emergence of anemia--A large cohort study

BACKGROUND AND OBJECTIVES

We aimed to find predictors for development of anemia in a large cohort of adults.

PATIENTS AND METHODS

Cohort study of a large health database from a screening center at the Rabin Medical Center in Israel, between the years 2000-2013. We asked which variables, known at the first visit, would predict anemia at the last visit. Multivariable analysis was conducted using stepwise logistic regression analysis. Odds ratios (ORs) for anemia with 95% confidence intervals (CIs) were calculated.

RESULTS

Our cohort included 10,577 people. At baseline 4.4% were diagnosed with anemia and excluded. Therefore, 10,093 subjects, with a mean age of 42.3 ± 9 years comprised our study sample. At the end of follow-up of 4.7 ± 3.1 years, 307 developed anemia (3%). In men, independent predictors for development of anemia were diabetes mellitus (OR 3.00, 95% CI 1.41-6.39), age (OR 1.03, 95% CI 1.03-1.05, for 1 year increment), low MCV (OR 0.92, 95% CI 0.89-0.96, for every 1 fL unit increment) and elevated platelet count (OR 1.004, 95% CI 1.00-1.01 for 1000/μL unit increment). For women, high total serum protein level was a strong predictor for anemia (OR 3.44, 95% CI 2.33-5.08 for 1mg/dL increment) as well as low triglycerides (OR 0.996, 95% CI 0.993-1.000 for 1mg/dL increment).

CONCLUSIONS

Subgroups who are prone to develop anemia include men with diabetes, and women with an elevated serum protein level and low triglycerides.

Is anemia a new cardiovascular risk factor?

Anemia is frequent in patients with cardiovascular disease and is often characterized as the fifth cardiovascular risk factor. It is considered to develop due to a complex interaction of iron deficiency, cytokine production and impaired renal function, although other factors, such as blood loss, may also contribute. Unfortunately, treatment of anemia in cardiovascular disease lacks clear targets and specific therapy is not defined. Treatment with erythropoietin-stimulating agents in combination with iron is the basic strategy but clear guidelines are not currently available. This review aims to clarify poorly investigated and defined issues concerning the relation of anemia and cardiovascular risk--in particular in patients with acute coronary syndromes and chronic heart failure--as well as the current therapeutic strategies in these clinical conditions.

Effect of Walking Exercise on Changes in Cardiorespiratory Fitness, Metabolic Syndrome Markers, and High-molecular-weight Adiponectin in Obese Middle-aged Women

[Purpose] The purpose of this study was to assess the effect of a 24-week exercise intervention on cardiorespiratory fitness, metabolic syndrome markers, and high-molecular-weight (HMW) adiponectin among obese middle-aged women. [Subjects] The subjects were 14 obese middle-aged women. [Methods] The exercise program involved walking at 50–60% of the maximum oxygen consumption, 3 times a week, for 24 weeks. Body composition analysis, blood pressure measurements, and blood analysis were performed before the exercise program and at weeks 6, 12, 18, and 24. [Results] The results showed that after 24 weeks in the exercise program, the obesity indices and metabolic risk factors, namely, weight, body fat, body mass index, waist circumference, systolic blood pressure, diastolic blood pressure, and triglycerides decreased significantly, whereas HDLC, a metabolic improvement factor, increased significantly. Additionally, VO_2max increased significantly, together with the level of total and HMW adiponectins. Correlation analysis of the changes in measured variables (∆ score) during resulting from the 24-week exercise program showed that body fat had a significant negative correlation and VO_2max had a significant positive correlation with HMW adiponectin. [Conclusion] Among obese middle-aged women, regular exercise increases cardiorespiratory fitness and HMW adiponectin expression and therefore can be effective in the prevention and treatment of obesity and metabolic syndrome.

Metabolic actions of natriuretic peptides and therapeutic potential in the metabolic syndrome

Natriuretic peptides (NPs) are a group of peptide-hormones mainly secreted from the heart, signaling via c-GMP coupled receptors. NP are well known for their renal and cardiovascular actions, reducing arterial blood pressure as well as sodium reabsorption. Novel physiological functions have been discovered in recent years, including activation of lipolysis, lipid oxidation, and mitochondrial respiration. Together, these responses promote white adipose tissue browning, increase muscular oxidative capacity, particularly during physical exercise, and protect against diet-induced obesity and insulin resistance. Exaggerated NP release is a common finding in congestive heart failure. In contrast, NP deficiency is observed in obesity and in type-2 diabetes, pointing to an involvement of NP in the pathophysiology of metabolic disease. Based upon these findings, the NP system holds the potential to be amenable to therapeutical intervention against pandemic diseases such as obesity, insulin resistance, and arterial hypertension. Various therapeutic approaches are currently under development. This paper reviews the current knowledge on the metabolic effects of the NP system and discusses potential therapeutic applications.

The adipose tissue as an endocrine organ

During the past 2 decades, results of both basic science and clinical studies have changed the physicians' views about adipocyte pathophysiology. Since leptin was discovered in 1994, white adipose tissue was recognized as an endocrine organ and an important source of biologically active substances with local and/or systemic action called adipokines. Inappropriate secretion of several adipokines by the excessive amount of white adipose tissue seems to participate in the pathogenesis of obesity-related pathologic processes including endothelial dysfunction, inflammation, atherosclerosis, diabetes mellitus, and chronic kidney disease. In this review endocrine action of selected adipokines (mainly leptin and adiponectin) in the context of kidney diseases is discussed. Specifically, the role of these adipokines in malnutrition, chronic kidney disease progression, and pathogenesis of cardiovascular complications is presented.

Anemia and reduced renal function are independent predictors of elevated serum adiponectin in elderly women

AIM

Although higher adiponectin levels predict a low risk of type 2 diabetes, elevated adiponectin levels predict higher mortality in older persons.

METHODS

We examined the associations of adiponectin with anthropometric, metabolic and hematological variables and renal function in 361 community-dwelling elderly women aged 76±8. Renal function was assessed using the estimated glomerular filtration rate (eGFR).

RESULTS

By univariate analysis, hemoglobin (r=-0.307, p<0.001) and creatinine-based eGFR (r=-0.121, p<0.05) were inversely associated with adiponectin. After adjustment for percentage body fat, HDL cholesterol and serum leptin, hemoglobin and creatinine-based eGFR remained independent predictors of adiponectin (standardized β coefficient=-0.248, p<0.0001, and -0.101, p=0.03, respectively). A similar but stronger relationship was observed between adiponectin and cystatin C-based eGFR (standardized β coefficient=-0.180, p=0.02). Elderly women with anemia had higher serum adiponectin than those without anemia (17.7±9.1 vs. 14.1±7.0 µg/mL, p=0.001). Women with creatinine-based eGFR <45 mL/min/1.73 m2 (19.2±10.6 µg/mL) had higher adiponectin than those with eGFR ≥45 -< 60 mL/min/1.73 m(2) (14.4±6.9 µg/mL) and those with eGFR ≥60 mL/min/1.73 m(2) (14.5±7.4 µg/mL, p<0.05).

CONCLUSIONS

We conclude that hemoglobin and eGFR are independently associated with serum adiponectin in community-dwelling elderly women. Anemia and reduced renal function may contribute to elevated adiponectin levels in the elderly and may represent important confounders of the relationship between elevated adiponectin and mortality in this population.

Adiponectin in renal disease--a review of the evidence as a risk factor for cardiovascular and all-cause mortality

Adiponectin, an adipokine, was discovered in 1995. The initial evidence led to the study of adiponectin as a determinant of insulin sensitivity and blood glucose levels. The literature then evolved to reports of the inverse association of adiponectin with incident Type 2 diabetes mellitus and coronary heart disease. Shortly thereafter, reports of a positive association with heart failure and mortality appeared and were replicated. We review here the basic science evidence and clinical studies of the role of renal function and kidney disease as a determinant of adiponectin.