HDL in CKD—The Devil Is in the Detail

Kronenberg, Florian

doi:10.1681/asn.2017070798

Cited by 78 publications

(62 citation statements)

References 162 publications

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“…Lipid metabolism is complex and involves multiple organs, cells and tissues, including the liver, intestine, plasma, macrophages and vascular endothelium, all of which can be affected by impaired kidney function 19,26 (Figure 1). As fats are hydrophobic and generally insoluble in plasma 26 , they are transported within hydrophilic lipoproteins with surface apolipoproteins [H2] Lipoprotein structure LDL-cholesterol has been a major focus of cardiovascular risk reduction in patients with CKD 16,18,19,22,24,[29][30][31][32] . However, the levels of LDL-cholesterol and total cholestrol are often within normal limits in these patients 19,24,25,[32][33][34][35][36] .…”

Section: [H2] Lipid Metabolismmentioning

confidence: 99%

Lipid management in patients with chronic kidney disease

Ferro¹,

Mark²,

Kanbay³

et al. 2018

Nat Rev Nephrol

170

142

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Glomerular filtration rate is inversely associated with cardiovascular disease independent of conventional risk factors. An increased risk of cardiovascular disease is present even at minor levels of renal impairment and the risk is highest in patients with endstage renal disease (ESRD) requiring dialysis. Renal dysfunction changes the level, composition, and quality of blood lipids in favour of a more atherogenic profile. Patients with advanced chronic kidney disease or ESRD have a characteristic lipid pattern of hypertriglyceridemia and low HDL-cholesterol levels but normal LDL-cholesterol levels. In the general population, a clear relationship exists between LDL-cholesterol, coronary heart disease and ischaemic stroke. However, in patients with ESRD, LDL-cholesterol seems to show a negative association [Au: with these outcomes?] at below average LDL-cholesterol levels and a flat or weakly positive association with mortality at higher LDL-cholesterol levels. Overall, the available data suggest that lowering of LDL-cholesterol is beneficial for prevention of major atherosclerotic events in patients with chronic kidney disease and in kidney transplant recipient but is not beneficial in patients requiring dialysis. [Au: I've moved the description of the content of your Review to the end of the introduction as per our journal style. To fully reflect the content of your article, please finish off the abstrace with a couple of sentences relating to novel lipid-lowering therapies and the need for reconsideration of the KDIGO guidelines in the light of new data. We have a limit of 200 words for this section.] [Au: I have highlighted suggestions for glossary terms throughout your manuscript with a [G]. Please provide succinct, one-sentence definitions for these specialist terms.] [H1] Introduction Guidelines regarding the management of lipids in patients with chronic kidney disease (CKD) and especially in those with end-stage renal disease (ESRD) are inconsistent in part owing to important deficiencies in the available data. [Au: Edit OK?] In 2013 KDIGO produced a comprehensive clinical practice guideline for lipid management in CKD 1. [Au: I suggest that we cite your original Table 1 (now Table 3) in the discussion of KDIGO recommendations at the end of the review so that the table is included next to this discussion in the final layout rather than in the introduction to the Review.

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Section: [H2] Lipid Metabolismmentioning

confidence: 99%

Lipid management in patients with chronic kidney disease

Ferro¹,

Mark²,

Kanbay³

et al. 2018

Nat Rev Nephrol

170

142

View full text Add to dashboard Cite

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“…Simple cholesterol measurement might not allow us to obtain the biologic functions of the specific HDL particles [39, 40]. Therefore, functional studies of each HDL component in the cholesterol efflux capacity and the reverse cholesterol transport, would be needed in the future [43]. …”

Section: Discussionmentioning

confidence: 99%

Association Between the Lipid Profile and Renal Dysfunction in the Heart Failure Patients

Zhang

Shi

Zhao

et al. 2019

Kidney Blood Press Res

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Background/Aims: In heart failure patients with high prevalence of chronic renal disease (CKD), hospitalization and mortality, whether the lipid profile was associated with renal dysfunction remained unknown. The present study intended to clarify the association between the lipid profile and renal dysfunction in the heart failure patients. Methods: 336 hospitalized heart failure patients with left ventricle ejection fraction (LVEF) ≤45% and New York Heart Association (NYHA) class II-IV were enrolled. The estimated glomerular filtration rate (eGFR) < 90 mL/min·1.73 m² was defined as renal dysfunction. The demographic, clinical data, blood samples and echocardiography were documented. The Pearson simple linear correlation was performed to evaluate the confounding factors correlated with eGFR. The significantly correlated factors were enrolled in Logistic regression as confounding factors to determine the association between the lipid profile and renal dysfunction in the heart failure patients. Results: 182 patients (54.2%) had renal dysfunction and 154 patients (45.8%) did not have renal dysfunction. The waist circumference, platelet counts, platelet distribution width (PDW), high density lipoprotein-cholesterol (HDL-C), apolipoprotein A1 (apoA1), albumin and left ventricular ejection fraction (LVEF) are positively correlated with eGFR (all P< 0.05). Meanwhile, the age, mean platelet volume (MPV), neutrophilic granulocyte percentage (NEUT%), urea nitrogen (BUN), creatinine and total bilirubin (TBIL) are negatively correlated with eGFR (all P< 0.05). The total cholesterol (TC), triglyceride, low density lipoprotein-cholesterol (LDL-C) and apolipoprotein B (apoB) show no correlation with eGFR. After the adjustment of sex, hypertension, diabetes mellitus, age, waist circumference, platelet counts, MPV, PDW, NEUT%, TBIL, albumin and LVEF, HDL-C is the only lipid factor still significantly associated with renal dysfunction in hospitalized heart failure patients (OR=0.119, P=0.003). Conclusion: Among the lipid profile of TC, triglyceride, LDL-C, HDL-C, apo A1 and apo B, the HDL-C is the only lipid factor significantly associated with renal dysfunction in hospitalized heart failure patients.

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“…In contrast, several European studies failed to demonstrate any relationship between HDL and all-cause or cardiovascular mortality [113,114]. In a large study of >33,000 hemodialysis patients, U-shaped association between HDL concentrations of <30 mg/dL and >60 mg/dL and increased risk for total and CVD mortality was observed [115,116]. The results of the Investigation of Lipid Level Management to Understand its Impact in Atherosclerotic Events (ILLUMINATE) trial assessing the impact of torcetrapib (CETP inhibitor) on clinical outcome indicated that despite the fact that the treatment significantly increased HDL levels, the risk of mortality and morbidity in patients at high risk for coronary events remained unchanged [117].…”

Section: Cardiovascular Risk Related To Modifications Of Hdl Particlementioning

confidence: 96%

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

Rysz

Gluba-Brzózka

Rysz-Górzyńska

et al. 2020

IJMS

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Chronic kidney disease (CKD) is a worldwide health problem with steadily increasing occurrence. Significantly elevated cardiovascular morbidity and mortality have been observed in CKD. Cardiovascular diseases are the most important and frequent cause of death of CKD patients globally. The presence of CKD is related to disturbances in lipoprotein metabolism whose consequences are dyslipidemia and the accumulation of atherogenic particles. CKD not only fuels the reduction of high-density lipoprotein (HDL) cholesterol concentration, but also it modifies the composition of this lipoprotein. The key role of HDL is the participation in reverse cholesterol transport from peripheral tissues to the liver. Moreover, HDL prevents the oxidation of low-density lipoprotein (LDL) cholesterol by reactive oxygen species (ROS) and protects against the adverse effects of oxidized LDL (ox-LDL) on the endothelium. Numerous studies have demonstrated the ability of HDL to promote the production of nitric oxide (NO) by endothelial cells (ECs) and to exert antiapoptotic and anti-inflammatory effects. Increasing evidence suggests that in patients with chronic inflammatory disorders, HDLs may lose important antiatherosclerotic properties and become dysfunctional. So far, no therapeutic strategy to raise HDL, or alter the ratio of HDL subfractions, has been successful in slowing the progression of CKD or reducing cardiovascular disease in patients either with or without CKD.

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HDL in CKD—The Devil Is in the Detail

Cited by 78 publications

References 162 publications

Lipid management in patients with chronic kidney disease

Lipid management in patients with chronic kidney disease

Association Between the Lipid Profile and Renal Dysfunction in the Heart Failure Patients

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

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