Relation of Serum Lipids and Lipoproteins with Progression of CKD

Abstract

Background and objectives Hyperlipidemia is common in patients with CKD. The objective of this study was to evaluate whether measures of plasma lipids and lipoproteins predict progression of kidney disease in patients with CKD.Design, setting, participants, & measurements Prospective cohort study in adults (n=3939) with CKD aged 21-74 years recruited between 2003 and 2008 and followed for a median of 4.1 years. At baseline, total cholesterol, triglycerides, very-low-density lipoprotein cholesterol (VLDL-C), LDL cholesterol (LDL-C), HDL cholesterol (HDL-C), apoA-I , apoB, and lipoprotein(a) [Lp(a)] were measured. The outcomes were composite end point of ESRD or 50% decline in eGFR from baseline (rate of change of GFR).Results Mean age of the study population was 58.2 years, and the mean GFR was 44.9 ml/min per 1.73 m 2 ; 48% of patients had diabetes. None of the lipid or lipoprotein measures was independently associated with risk of the composite end point or rate of change in GFR. However, there were significant (P=0.01) interactions by level of proteinuria. In participants with proteinuria,0.2 g/d, 1-SD higher LDL-C was associated with a 26% lower risk of the renal end point (hazard ratio [HR], 0.74; 95% confidence interval [95% CI], 0.59 to 0.92; P=0.01), and 1-SD higher total cholesterol was associated with a 23% lower risk of the renal end point (HR, 0.77; 95% CI, 0.62 to 0.96; P=0.02). In participants with proteinuria.0.2 g/d, neither LDL-C (HR, 0.98; 95% CI, 0.98 to 1.05) nor total cholesterol levels were associated with renal outcomes. Treatment with statins was reported in 55% of patients and was differential across lipid categories.Conclusions In this large cohort of patients with CKD, total cholesterol, triglycerides, VLDL-C, LDL-C, HDL-C, apoA-I, apoB, and Lp(a) were not independently associated with progression of kidney disease. There was an inverse relationship between LDL-C and total cholesterol levels and kidney disease outcomes in patients with low levels of proteinuria.

Lipoprotein (a): impact by ethnicity and environmental and medical conditions

“…Further, a mild glomerular filtration rate impair ment was associated with a higher Lp(a) level in a recent study of diabetic patients (172). In other studies, however, Lp(a) concentrations did not differ from those of controls (173)(174)(175)(176)(177). In a large multicenter study, Kronenberg et al (145) reported higher Lp(a) levels in patients undergoing continuous ambulatory peritoneal dialysis compared with HD.…”

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

“…Second, the decreased apoA1 and lecithin cholesterol acyltransferase deficiency were often documented in patients with kidney dysfunction, they could lead to lower plasma HDL-C [40, 41]. On the contrary, in a large cohort of 3939 patients with CKD, the total cholesterol, triglycerides, VLDL-C, LDL-C, HDL-C, apoA1, and apoB were not independently associated with progression of kidney disease [42]. The reason may be that the HDL particle is highly complicated and over 80 proteins and several hundred lipids are carried within it.…”

Prognostic role of LDL cholesterol in non-dialysis chronic kidney disease: Multicenter prospective study in Italy

“…Nevertheless, the CV risk associated with cholesterol levels has been investigated in ND-CKD by few studies and with controversial results [4e9]. Few and conflicting data have also been reported on the association between hypercholesterolemia and CKD progression [10,11]. Therefore, the prognostic role of LDL remains ill-defined in ND-CKD; in fact, the most recent clinical practice guidelines have provided inconsistent recommendations on the risk profile indicating cholesterol-lowering therapy in CKD [12e14].…”