{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,15]],"date-time":"2025-08-15T02:32:39Z","timestamp":1755225159604,"version":"3.43.0"},"reference-count":43,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,8,13]],"date-time":"2025-08-13T00:00:00Z","timestamp":1755043200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>Elevated levels of retinol-binding protein 4 (RBP4) have been linked to conditions including cardiovascular disease, type 2 diabetes, obesity, and insulin resistance. However, the associations between baseline and longitudinal RBP4 levels with all-cause mortality in maintenance hemodialysis patients remain uncertain. The aim of this study was to investigate this issue.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A total of 342 consecutive patients undergoing maintenance hemodialysis at a single hemodialysis center between 2010 and 2022 were assessed. Enzyme-linked immunosorbent assay was used to quantify plasma RBP4 concentrations. Patient outcomes were assessed using Cox regression and Kaplan-Meier analyses.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Non-survivors were associated with significantly lower baseline and longitudinal RBP4 levels compared to the survivors. A trend toward reduced all-cause mortality was found across quartiles of baseline and longitudinal RBP4 levels (p for trend &amp;lt; 0.0001). Multivariate analysis showed that the patients in the lowest quartiles (Quartile 1) of baseline and longitudinal RBP4 levels had hazard ratios of 2.22 (95% CI: 1.16-4.31) and 2.44 (95% CI: 1.30-4.84) for all-cause mortality, respectively, compared to those in the fourth quartile. In contrast to the non-survivors, the survivors had significantly higher plasma RBP4 levels during the 1-year follow-up period compared to the levels at the initiation of hemodialysis (p = 0.001). In addition, a positive association was observed between baseline RBP4 concentration and albumin level, while negative associations were observed between baseline RBP4 concentration and levels of aspartate aminotransferase, high-sensitivity C-reactive protein, and mean corpuscular volume. Structural equation model analysis confirmed the effect of RBP4 on mortality.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>Associations were identified between low baseline and longitudinal RBP4 plasma concentrations and all-cause mortality in our cohort of Taiwanese maintenance hemodialysis patients.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fendo.2025.1434757","type":"journal-article","created":{"date-parts":[[2025,8,13]],"date-time":"2025-08-13T07:00:41Z","timestamp":1755068441000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Association of baseline and longitudinal plasma retinol-binding protein 4 with all-cause mortality in maintenance hemodialysis patients"],"prefix":"10.3389","volume":"16","author":[{"given":"Thung-Lip","family":"Lee","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chao-Ping","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chin-Feng","family":"Hsuan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chia-Chang","family":"Hsu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yung-Chuan","family":"Lu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wei-Hua","family":"Tang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ching-Ting","family":"Wei","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ya-Ai","family":"Cheng","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fu-Mei","family":"Chung","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yau-Jiunn","family":"Lee","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"I-Ting","family":"Tsai","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,8,13]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jfma.2021.12.015","article-title":"Mortality rate of end-stage kidney disease patients in Taiwan","author":"Wu","year":"2022","journal-title":"J Formos Med Assoc"},{"key":"B2","doi-asserted-by":"publisher","first-page":"502","DOI":"10.1186\/s12882-020-02135-7","article-title":"Survival and analysis of predictors of mortality in patients undergoing replacement renal therapy: a 20-year cohort","volume":"21","author":"Ferreira","year":"2020","journal-title":"BMC Nephrol"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.120.050686","article-title":"Cardiovascular disease in chronic kidney disease: pathophysiological insights and therapeutic options","volume":"143","author":"Jankowski","year":"2021","journal-title":"Circulation"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1001\/jamacardio.2019.0375","article-title":"Risk of cardiovascular disease and mortality in young adults with end-stage renal disease: an analysis of the US renal data system","volume":"4","author":"Modi","year":"2019","journal-title":"JAMA Cardiol"},{"key":"B5","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1007\/978-981-13-8871-2_1","article-title":"Prevalence and disease burden of chronic kidney disease","volume":"1165","author":"Lv","year":"2019","journal-title":"Adv Exp Med Biol"},{"key":"B6","doi-asserted-by":"publisher","first-page":"453892","DOI":"10.1155\/2010\/453892","article-title":"Role of reactive oxygen species in the progression of type 2 diabetes and atherosclerosis","volume":"2010","author":"Kaneto","year":"2010","journal-title":"Mediators Inflamm"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gfp001","article-title":"The plasma retinol levels as pro-oxidant\/oxidant agents in hemodialysis patients","volume":"24","author":"Roehrs","year":"2009","journal-title":"Nephrol Dial Transplant"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2362.1973.tb00362.x","article-title":"Metabolism of the vitamin A transporting protein complex. 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