Concentration of Lp(a) and other Apolipoproteins in Predialysis, Hemodialysis, Chronic Ambulatory Peritoneal Dialysis and Post-Transplant Patients

Abstract

Serum levels of lipids, lipoprotein(a) Lp(a) and other apolipoproteins were determined in 47 predialysis patients, 40 hemodialysis (HD) patients, 39 chronic ambulatory peritoneal dialysis (CAPD) patients, 11 patients after kidney transplantation and 47 healthy subjects as reference group. The predialysis, HD, and CAPD patients had disturbances in the concentration of serum triglyceride (TG), high density lipoprotein (HDL)-cholesterol, apolipoprotein AI (apoAI), total apoCIII, apoCIII present in the particles without apoB (apoCIII non B), and Lp(a) and HDL-cholesterol, low density lipoprotein (LDL)-cholesterol/HDL-cholesterol, HDL-cholesterol/apoAI, apoAI/apoB, and apoAI/apoCIII ratios. Predialysis patients had significantly lower concentrations of HDL-cholesterol and total apoE levels than CAPD patients and total apoE level than HD patients. Moreover, both HD and CAPD patients had significantly increased levels of apoB containing apoE (apoB:E) and apoB containing apoCIII (apoB:CIII). The concentrations of serum TG, total cholesterol, LDL-cholesterol, apoB, Lp(a) in CAPD patients were statistically higher than in HD patients. The patients after transplantation demonstrated normalization of lipid and lipoprotein parameters and lipoprotein ratios except serum levels of TG, total apoCIII, apoCIII non B and the apoAI/apoCIII ratio. We concluded that abnormal lipid and lipoprotein concentrations in patients with uremia may be the cause of their high risk of atherosclerosis, but posttransplant patients exhibited improved levels of serum lipids, Lp(a) and other lipoprotein parameters and lipoprotein composition, which could be an index of decreased atherogenic status.

Survival Advantage of Normal Weight in Peritoneal Dialysis Patients

“…Previous study showed that abnormal concentrations of Lp(a) in patients with endstage renal disease might be the cause of the high risk of atherosclerosis. 19 In this study, the serum levels of Lp(a) were significantly higher in overweight patients, which may be related to high cardiovascular disease, therefore contributed to increased mortality in overweight patients. The research also showed that serum levels of CRP were significantly higher in overweight patients than in normal weight patients, which was in accord with the results from de Araujo Antunes et al 20 At the same time, linear regression analysis found that CRP was a significant risk factor associated with BMI.…”

Mortality Differences by Dialysis Modality among Incident ESRD Patients with and without Coronary Artery Disease

“…It has also been shown that patients treated with PD have higher levels of serum triglycerides, total cholesterol, LDL, and lower levels of high-density lipoproteins compared with HD-treated patients (12)(13)(14). Furthermore, comparisons of PD and HD patients have found greater increases in lipoprotein (a) levels in those treated with PD (12). Such evidence points to PD as being more proatherogenic.…”

“…Previous studies have demonstrated that certain cardiovascular conditions, including fatal stroke and left ventricular hypertrophy occur with greater frequency in patients treated with PD compared with HD (36 -39). It has also been shown that patients treated with PD have higher levels of serum triglycerides, total cholesterol, LDL, and lower levels of high-density lipoproteins compared with HD-treated patients (12)(13)(14). Furthermore, comparisons of PD and HD patients have found greater increases in lipoprotein (a) levels in those treated with PD (12).…”

“…On one hand, PD may offer patients better BP control, less hemodynamic shear stress, and avoidance of the peaks and troughs in uremic toxins that are common with HD (10). On the other hand, because of unfavorable lipid profiles and elevated serum glucose, PD may accelerate preexisting CAD through increased glycosylation and lipid oxidation (11)(12)(13)(14)(15)(16). The selection of HD for patients with CAD may also have untoward effects on the coronary vasculature mediated by increased oxidative stresses and inflammatory mediators (17,18).…”

Hemodialysis Leads to Better Survival in Patients with Diabetes or High Comorbidity, Compared to Peritoneal Dialysis

“…Several reasons for the higher mortality of patients treated with PD were proposed. First, the serum lipoprotein (a) (Kimak et al 2000;Kronenberg et al 2003) and hyperlipidemia (Lee et al 1998;Kronenberg et al 2003) levels are reported to be higher in patients undergoing PD than in patients undergoing HD. Accelerated atherosclerosis may occur in the PD patients.…”