Kidney Week

Abstract: TH-PO0318

Reduced Apelin-13 and Impaired Cardiovascular Functional Capacity in Patients Undergoing Hemodialysis

Session Information

• Hypertension and CVD: Clinical - 1
  November 06, 2025 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Hypertension and CVD

• 1602 Hypertension and CVD: Clinical

Authors

• Campos, Monique Opuszcka, Indiana University School of Medicine, Indianapolis, Indiana, United States

Monique Opuszcka Campos, PhD

• Jain, Krishan Gopal, Indiana University School of Medicine, Indianapolis, Indiana, United States

Krishan Gopal Jain, PhD

• Narayanan, Gayatri, Indiana University School of Medicine, Indianapolis, Indiana, United States

Gayatri Narayanan, MS

• Alarcon Acurero, Leonardo Jose, Indiana University School of Medicine, Indianapolis, Indiana, United States

Leonardo Jose Alarcon Acurero

• Groninger, Nolan, Indiana University School of Medicine, Indianapolis, Indiana, United States

Nolan Groninger, MPH

• Lu, Tzongshi, Harvard Medical School, Boston, Massachusetts, United States

Tzongshi Lu, PhD

• Lim, Kenneth, Indiana University School of Medicine, Indianapolis, Indiana, United States

Kenneth Lim, MD, PhD, FASN

Background

Cardiovascular functional capacity (CVC) is markedly reduced in advanced CKD patients on dialysis and is linked to disease progression, morbidity, and mortality. Apelin-13 is a circulating peptide hormone that is emerging as a promising therapeutic target for cardiovascular disease. Despite its potential, the role of Apelin-13 in CV alterations in CKD is unexplored. This study evaluated Apelin-13 levels in hemodialysis (HD) patients and healthy controls, and its association with VO₂Peak, (gold-standard index of CVC).

Methods

We conducted a cross-sectional study with 72 participants, comprising n=52 patients on thrice-weekly HD, and an age- and gender-matched healthy control group from the SPARK, ECON, and ROCK-D cohorts. All participants underwent cardiopulmonary exercise testing (CPET). Plasma Apelin-13 levels were measured via ELISA (Novus Biologicals). Group comparisons used t-test or Mann-Whitney U test. Inferential analysis was performed using univariate and multiple regression.

Results

The HD group had a higher BMI, and greater prevalence of black participants, hypertension, diabetes, beta-blocker use, and lower hemoglobin levels (all P<0.05). Resting heart rate (HR) was higher in the HD group despite similar blood pressure (76.2 ± 10.4 vs 63.5 ± 8.7 bpm, P<0.001). Significantly, Apelin-13 levels were lower in HD group compared to controls (1090 (817, 1383) vs 2172 (1668, 3385) pg/mL, P<0.001). In parallel, VO₂Peak was substantially impaired in the HD group (12.2 (10.2, 15.3) vs 29.4 (26.9, 36.4) mL/min/kg, P<0.001), as were circulatory power (1915 (1525, 2472) vs 6350 (4881, 7469) mmHg.mL/min/kg, P<0.001) and HR peak (111 ± 17.4 vs 160 ± 15.0 bpm, P<0.001). The VE/VCO₂ slope did not differ between groups. Apelin-13 levels were significantly associated with VO₂Peak (β=0.004), circulatory power (β=0.72), maximal workload (β=0.03), and HR peak (β=0.009, all P’s<0.001). These associations remained significant even after adjusting for age, sex, and race on multiple regression.

Conclusion

Apelin-13 levels are deficient in patients on dialysis and are significantly associated with CVC impairment. These findings provide strong rationale for further research into its therapeutic role in patients with CKD.

Funding

• Private Foundation Support

Digital Object Identifier (DOI)

• doi: 10.1681/ASN.202562hzrhd8