2016
DOI: 10.1681/asn.2016030262
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HDL Cholesterol Efflux Does Not Predict Cardiovascular Risk in Hemodialysis Patients

Abstract: The cardioprotective effect of HDL is thought to be largely determined by its cholesterol efflux capacity, which was shown to inversely correlate with atherosclerotic cardiovascular disease in populations with normal kidney function. Patients with ESRD suffer an exceptionally high cardiovascular risk not fully explained by traditional risk factors. Here, in a analysis in 1147 patients with type 2 diabetes mellitus on hemodialysis who participated in the German Diabetes Dialysis Study (4D Study), we investigate… Show more

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Cited by 51 publications
(41 citation statements)
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“…HDL-c cholesterol efflux capacity (CEC) plays a central role in RCT and is regarded as a key metric of HDL-c functionality. However, CEC did not predict the incidence of cardiovascular events in patients with CKD in the German Diabetes Dialysis Study (4D Study) [35] and the CARE FOR HOME study [36]. Further studies are needed to test whether other potential atheroprotective activities of HDL-c (e.g., antioxidant and anti-inflammatory properties, increased endothelial nitric oxide production) predict cardiovascular events in CKD patients [37].…”
Section: Discussionmentioning
confidence: 99%
“…HDL-c cholesterol efflux capacity (CEC) plays a central role in RCT and is regarded as a key metric of HDL-c functionality. However, CEC did not predict the incidence of cardiovascular events in patients with CKD in the German Diabetes Dialysis Study (4D Study) [35] and the CARE FOR HOME study [36]. Further studies are needed to test whether other potential atheroprotective activities of HDL-c (e.g., antioxidant and anti-inflammatory properties, increased endothelial nitric oxide production) predict cardiovascular events in CKD patients [37].…”
Section: Discussionmentioning
confidence: 99%
“…In another analysis of samples and data from the 4D study, it was noted that patients with the lowest HDL cholesterol efflux activity significantly benefitted from atorvastatin therapy raising the possibility that using this index may assist in identifying patients who are most likely to benefit from statins. 60 Furthermore, it has been reported that atorvastatin treatment reduced the risk of reaching the study primary endpoints in the 4D study in patients with the lowest intestinal cholesterol absorption (lowest tertile). 63 While these post hoc analyses should not influence current treatment decisions, future studies in patients with ESRD treated with hemodialysis will need to take into account these important patient-specific factors.…”
Section: On Outcomes In Ckd and Esrdmentioning
confidence: 99%
“…Several laboratory markers of HDL function in ESRD have been studied thus far, however, none have proven to have clinical utility. For instance, higher HDL cholesterol efflux activity has not been found to be associated with improved outcomes in hemodialysis and renal transplant patients . Future studies will need to examine HDL composition, antioxidant, anti‐inflammatory and HDL cholesterol influx/unloading capacity as clinical tools in evaluating risk in patients with ESRD…”
Section: Association Of Serum Lipids and Lipoproteins Levels With Outmentioning
confidence: 99%
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“…Moreover, restoration of renal function by transplantation is associated with an enhancement of these capacities without retrieving normal-HDL levels [92]. Nevertheless, Kopecky et al sowed the seeds of doubt by showing that cholesterol efflux levels capacity in diabetic HD patients is not a prognostic marker of cardiovascular events [96]. …”
Section: Uremic Lipoproteins Evidences Of Toxicitymentioning
confidence: 99%