Kidney Function as a Determinant of HDL and Triglyceride Concentrations in the Australian Population

Abstract

Background: Chronic kidney disease (CKD) is a potent risk factor for cardiovascular disease (CVD). CVD risk increases in a stepwise manner with increasing kidney impairment and is significantly reduced by kidney transplantation, suggesting a causal relationship. Dyslipidemia, a well recognised CVD risk factor, is highly prevalent in CKD. While dyslipidemia is a risk factor for CKD, kidney impairment can also induce a dyslipidemic state that may contribute to the excess burden of CVD in CKD. We utilised a multipronged approach to determine whether a causal relationship exists. Materials and Methods: Retrospective case-control analysis of 816 patients admitted to the Royal Hobart Hospital in 2008–2009 with different degrees of kidney impairment and retrospective before-after cohort analysis of 60 patients who received a transplanted kidney between 1999 and 2009. Results: Decreased estimated GFR (eGFR) was independently associated with decreased high density lipoprotein (HDL, p < 0.0001) and increased triglyceride concentrations (p < 0.01) in multivariate analysis. There was no significant relationship between eGFR and low density lipoprotein (LDL) or total cholesterol in multivariate analysis. Kidney transplantation increased HDL (p < 0.0001) and decreased triglyceride (p = 0.007) concentration, whereas there was no significant change in LDL and total cholesterol. These effects were dependent on maintenance of graft function, statin therapy (those who were on) if graft failure occurred then HDL again decreased and triglycerides increased. Conclusions: Kidney transplantation ameliorated alterations in plasma lipoprotein profile associated with kidney impairment, an effect that was dependent on the maintenance of graft function. These data suggest that kidney function is a determinant of HDL and triglyceride concentrations in patients with CKD.

Association of renal function with clinical parameters and conditions in a longitudinal population-based epidemiological study

“…In addition, eGFR was observed to correlate inversely with hyper-LDL-cholesterolemia in the control subjects. These results were consistent with a previous report (25), showing a causal association with early and advanced stages of renal dysfunction.…”

Lipid management in patients with chronic kidney disease

“…This impaired HDL-cholesterol metabolism in CKD leads to the accumulation of immature HDL particle precursors with limited anti-oxidative and anti-inflammatory potential 34,[50][51][52] . Renal transplant recipients often have high levels of HDL-cholesterol but are not protected against atherogenesis, probably as a direct result of the reduced quality of these HDL particles 13,53 .…”

The Role and Function of HDL in Patients with Chronic Kidney Disease and the Risk of Cardiovascular Disease

“…In kidney transplant patients, the restoration of kidney function results in a significant increase in HDL (p < 0.0001); however, if the graft function is not maintained, HDL level reduction is observed (p < 0.01) [77]. In turn, Kopecky et al [78] demonstrated that HDL from renal transplant recipients had strikingly altered molecular composition, mainly the enrichment in two proteins (SAA and SP-B), and it exerted impaired biological functions.…”