Adiponectin is an adipocyte-specific cytokine that has a

protective role in the development of cardiovascular

morbidities. As chronic kidney disease progresses,

adiponectin levels increase and cardiovascular risk profiles

change. Here we determined the association of baseline and

longitudinal changes in adiponectin with different

cardiovascular outcomes in 1255 type 2 diabetic

hemodialysis patients in the German Diabetes and Dialysis

Study. Within 4 years of follow-up, the hazard ratios to reach

pre-specified, adjudicated end points were determined. The

increased risk of cardiovascular events observed with high

adiponectin levels at baseline was associated with high risks

of sudden death and stroke but not of myocardial infarction.

Adiponectin was negatively correlated with C-reactive

protein and positively correlated with NT-pro-BNP, the latter

significantly attenuating the associations with adverse

outcome. Increased longitudinal levels of adiponectin during

follow-up were associated with higher risks of adverse

cardiovascular outcomes and death; associations weakened

by a confounding effect of increased NT-pro-BNP. Our study

suggests that high basal and increasing adiponectin levels in

the dialysis population largely reflect a consequence of

disease circumstances. Most likely, this rise is a counterregulatory

response to worsening health in keeping with

adiponectin’s potential to counteract inflammation.