The Effect of Glycemic Status on Serum Adipokines and Conventional Risk Factors Involved in Cardiovascular Diseases in Hemodialysis

Introduction: Cardiovascular diseases (CVD) are among the major causes of morbidity and mortality in hemodialysis. Insulin resistance (IR) is an independent predictor of cardiovascular mortality in advance renal failure. Traditional CVD risk factors could not entirely justify the burden of disease; thus, the potential role of novel mediators like adipokines is of interest in these patients. Zinc-α2-glycoprotein (ZAG) and adipose triglyceride lipase (ATGL) are adipokines that proposed to be correlated with cardiovascular risk factors including impaired lipid metabolism, inflammation, endothelial dysfunction and IR. This study aimed to investigate the effect of glycemic status on serum adipokines and other CVD risk factors.
Methods: Serum levels of ZAG, ATGL and its metabolites free fatty acids (FFAs), and other CVD risk factors were assessed in 59 patients with hemodialysis, considering diabetes and IR status.
Results: There was no significant difference in lipid profile, hsCRP, nitric oxide metabolites and adipokines between diabetic and non-diabetic patients. However, when patients were divided according to median values of HOMA, ZAG was significantly lower (94.9±34.5 vs. 112.9±31.7 ng/mL, P=0.046), and ATGL (12.3±9.6 vs. 9.1±5.2 mIU/mL, P=0.079) and FFAs (249.9±120.8 vs. 167.8±98.4 ng/mL, P=0.004) were marginally and significantly higher in group with higher HOMA values. No other significant difference was observed between groups.
Conclusion: IR degree in hemodialysis patients, might affect adipokines correlated with CVD, independent of diabetes. None of diabetes or IR could predict conventional CVD risk factors in uremic patients. Understanding the complicated relationship between novel and conventional CVD risk factors, uremia, and IR needs further investigations.