Oxidized High-Density Lipoprotein Is Associated with Protein-Energy Wasting in Maintenance Hemodialysis Patients

Abstract

Background and objectives: Oxidized HDL (oxHDL) may behave as proinflammatory HDL because of reduced antiinflammatory capacity and is considered a risk factor for mortality in patients on maintenance hemodialysis (MHD). The study presented here assessed the effect of oxHDL on protein-energy wasting (PEW) in MHD patients.Design, setting, participants, & measurements: This prospective study examined a cohort of MHD patients (n ‫؍‬ 176) who were not taking lipid-lowering drugs. Blood samples were obtained to measure albumin, lipids, high-sensitivity C-reactive protein (hsCRP), oxidized LDL (oxLDL), and oxHDL. PEW was assessed by subjective global assessment (SGA) and geriatric nutritional risk index (GNRI). Measurements and assessment of nutritional status were followed up 1 year later.Results: OxHDL was significantly increased in patients with PEW at baseline. High oxHDL and high hsCRP were significantly associated with PEW, and receiver operating characteristic curves for oxHDL and hsCRP showed statistically similar accuracy for predicting SGA-positive status. According to multivariate regression models, high oxHDL had a significant influence on PEW in patients, particularly those with high hsCRP. Decreased changes in GNRI and high prevalence of SGA-positive status at 1 year were more common in patients with high oxHDL at baseline and 1 year later than in patients with low oxHDL at both time points.Conclusions: A high oxHDL state may be associated with PEW estimated by GNRI and SGA, particularly concomitant with inflammation in MHD patients.

Oxidized high-density lipoprotein is associated with increased plasma glucose in non-diabetic dyslipidemic subjects

“…They also had a normal fasting PG level but were dyslipidemic [23] (elevated LDL-C [n = 110, 71%], decreased HDL-C [n = 4, 3%] and elevated TG [n = 57, 37%], respectively). The median level of serum oxHDL was 136 U/ml, which is not significantly lower than that previously observed in chronic renal failure patients [21,22]. …”

“…This assay has been tested in several clinical settings, and increased oxHDL has been found in diabetic patients [20] and was reported to be predictive of CVD outcomes in chronic renal failure patients treated by hemodialysis [21,22]. The aim of the present study is to investigate the relationship between fasting plasma glucose (PG) and oxHDL, as well as other cardiovascular lipid/lipoprotein risk factors, in non-diabetic, dyslipidemic subjects to determine if the oxHDL assay can be potentially be applied in a more general population.…”

Serum Amyloid A in Uremic HDL Promotes Inflammation

“…It has been suggested that oxidized HDL in ESRD patients may be causally linked to cardiovascular complications of uremia, but this suggestion has not been rigorously tested. 23,[27][28][29] We were unable to detect oxidized HDL in ESRD in vivo, and there was no difference in the susceptibility of HDL from control and ESRD patients to ex vivo oxidation induced by peroxyl radicals, which was assessed by the extent of oxidized apoA-I/II containing methionine sulfoxide(s). We did not determine the extent of lipid (per)oxidation in these experiments.…”

Assessment of Inflow of Endotoxin and Its Fragments in Patients on Maintenance Hemodialysis

“…Second-generation Kt/V was estimated using the Daugirdas formula to calculate the dialysis dosage. PEW was determined by subjective global assessment [18]. …”