High Prevalence of Anti‐Apolipoprotein/A‐1 Autoantibodies in Maintenance Hemodialysis and Association With Dialysis Vintage

Abstract

Autoantibodies to apolipoprotein/A-1 (anti-ApoA-1 IgG) have pro-atherogenic properties in patients at high cardiovascular risk, but its prevalence in patients with end-stage kidney disease is unknown. The aims of this single-center, cross-sectional study were to assess the prevalence of anti-ApoA-1 antibodies in patients on maintenance hemodialysis (MHD), and to examine its correlation with inflammatory biomarkers related to atherosclerotic plaque vulnerability and dialysis vintage. To this purpose, anti-ApoA-1 IgG levels and the concentrations of interleukin-6 (IL-6), interleukin-8 (IL-8), monocyte chemoattractant protein-1 (MCP-1), metalloproteinase-9 (MMP-9), tumor necrosis factor-α, and C-reactive protein (CRP) were assessed in the sera of 66 MHD patients (mean age: 68 ± 14 years, 36% women, 32% diabetics). Anti-ApoA-1 IgG positivity (defined as a blood value ≥ 97.5(th) percentile of the normal distribution as assessed in healthy blood donors) was 20%. Circulating levels of anti-ApoA-1 IgG correlated positively with dialysis vintage, but not with cardiovascular risk factors or previous cardiovascular events; no significant correlations were found between the anti-ApoA1 IgG levels and circulating levels of IL-6, IL-8, MCP-1, MMP-9, CRP, or low-density lipoprotein-cholesterol. In multivariable linear regression, adjusted for age and sex, only dialysis vintage remained positively and independently associated with anti-ApoA-1 titers (β = 0.05, 95% CI: 0.006; 0.28, P = 0.049). In conclusion, the prevalence of anti-ApoA-1 IgG is raised in the MHD-population, and positively associated with dialysis vintage, a major determinant of cardiovascular outcome. Whether antiApoA-1 antibodies play a role in the pathophysiology of accelerated atherosclerosis in the MHD-population merits further study.

Vitamin E tocotrienol supplementation improves lipid profiles in chronic hemodialysis patients

“…In the context of ESRD patients, because kidney functions are impaired, this also hypothetically leads to reduction of ApoA1 catabolism. Conversely, a recent study showed that ESRD patients on HD have higher prevalence of autoantibodies to ApoA1 (anti-ApoA1 IgG) which correlates with dialysis vintage 57. Similarly, in a comparative study between healthy control and HD patients, Pahl et al58 found that plasma HDLC is markedly reduced in HD patients, which was mirrored by reduced ApoA1 plasma concentration.…”

Effect of serum FGF‐23, MGP and fetuin‐A on calcium‐phosphate metabolism in maintenance hemodialysis patients

“…Pruijm et al 33 found that the prevalence of anti-ApoA-1 IgG was raised and positively associated with dialysis vintage. Pruijm et al 33 found that the prevalence of anti-ApoA-1 IgG was raised and positively associated with dialysis vintage.…”

ApoA1 and ApoA1-specific self-antibodies in cardiovascular disease

“…108 The titers of ApoA1 antibodies correlated with dialysis vintage, a major determinant of vascular calcification and cardiovascular risk in patients with kidney failure. 109 Finally, type 2 diabetic patients who were positive for ApoA1 antibodies also had significantly higher cardiovascular risk compared with ApoA1 IgG-negative diabetic subjects thereby indicating that anti-apoA-1 IgG is a cardiovascular risk biomarker in diabetic patients. 110 The presence of anti-HDL antibodies was recently reported.…”