Adiponectin in chronic kidney disease: a complex and context sensitive clinical situation.

Although hyperadiponectinemia is a common phenomenon in chronic kidney disease and is considered to have similar beneficial effects on metabolic risk in this patient group, many recent studies in general population have unexpectedly shown that high, rather than low, concentrations predict mortality. However, the apparent unfavorable effect of high adiponectin might not necessarily be exclusively or partially related to a direct effect of adiponectin, but rather it could be a consequence of a concurrent process of wasting (or pathogenic pathways linked to the wasting process) which may increase adiponectin levels. It is also possible that elevated circulating adiponectin levels mirror a state of volume and salt overload because natriuretic peptides and high salt intake were recently shown to stimulate secretion of adiponectin. Until nutritional and pharmacological treatment strategies that increase adiponectin in uremic patients can be advocated nephrologists have an important task to unravel the observed paradoxes.