K/DOQI clinical practice guidelines for cardiovascular disease in dialysis patients.

Atherosclerosis and arteriosclerosis in chronic renal failure.

BACKGROUND Although serum lipoprotein(a) [Lp(a)] is an independent risk factor for atherosclerosis in the general population and Lp(a) levels are increased in hemodialysis patients, an association of Lp(a) with the risk of clinical events attributed to atherosclerosis has not been established in the chronic hemodialysis patient population. We therefore determined the association between Lp(a) levels and the risk of clinical events of presumed atherosclerotic etiology in a prospective study of an outpatient hemodialysis population. METHODS AND RESULTS Lp(a) was measured by radioimmunoassay in a baseline cardiovascular disease risk assessment in a consecutive series of 129 hemodialysis patients. The relation between baseline Lp(a) and clinical events of presumed atherosclerotic etiology was determined during 48 months of follow-up. Hemodialysis patients had a median Lp(a) concentration that was approximately four times as high as the median Lp(a) concentration in normal controls and twice as high as the levels in controls with angiographic evidence of coronary artery disease [median Lp(a), 38.4 versus 16.9 mg/dl; p less than 0.001]. Baseline Lp(a) levels were no different in participants with or with no history of a previous clinical event at the time of the baseline examination. However, baseline Lp(a) concentration (p less than 0.001) and a history of atherosclerotic clinical events (p = 0.001) were associated with clinical events during the period of follow-up. In contrast, baseline serum total cholesterol, triglyceride, high density lipoprotein cholesterol, low density lipoprotein cholesterol, age, gender, race, or duration of hemodialysis were unrelated to this risk in the prospective study. Stepwise multiple logistic regression analysis demonstrated that serum Lp(a) concentration (p = 0.001) and the presence of a previous clinical event (p = 0.004) were the only independent contributors to the risk of a clinical event during the period of follow-up. CONCLUSIONS Lp(a) is an independent risk factor for clinical events attributed to atherosclerotic cardiovascular disease in patients receiving chronic hemodialysis treatment of end-stage renal disease.

Lipoprotein(a) is an independent risk factor for cardiovascular disease in hemodialysis patients.

https://www.ajkd.org/article/S0272-6386(12)80827-4/pdf

Cardiovascular risk factors in chronic renal failure and hemodialysis populations

Lipoprotein(a) (Lp[a]) can be defined as a lipoprotein particle having as a protein moiety apolipoprotein B-100 (the protein associated with low-density lipoprotein) disulfide-linked to apolipoprotein(a), the distinctive glycoprotein of Lp(a) that is homologous to plasminogen. Several forms of Lp(a) occur in the circulation. This polymorphism is related to the apolipoprotein(a) size heterogeneity that is controlled by the several alleles of the apolipoprotein(a) gene. High plasma levels of Lp(a) have been correlated with an increased risk for atherothrombotic cardiovascular disease by a mechanism that is as yet undefined. Pathogenicity may also derive from Lp(a) particles that have been modified by events believed to occur when Lp(a), after traversing the artery endothelium, reaches the intima. Aside from several promising leads, there are no universally accepted ways to lower high plasma Lp(a) levels. At this time, it is best to target efforts toward the modifiable risk factors by using appropriate diets and exercise programs and, whenever necessary, drug therapy. (JAMA. 1992;267:3326-3329)

https://jamanetwork.com/HttpHandlers/ArticlePdfHandler.ashx?journal=JAMA&articleId=398068&pdfFileName=jama_267_24_040.pdf

Lipoprotein(a). A genetic risk factor for premature coronary heart disease.

CLINICALCHEMISTRY, Vol. 33, No. 5, 1987 721 Lp(a) Lipoprotein in Patients with Chronic Renal Failure Treated by Hemodialysis, H. J. Parra,’ H. Mezdour,’ C. Cachera,1 M. Dracon,2 A. Tacquet,2 and J. C. Fruchart’ (1 Serlia et U. Inserm 279, Institut Pasteur, 1, rue du Pr Calmette, 59019 Lille C#{233}dex, France; 2 Laboratoire de N#{233}phrologie du S#{232}me Centre, H#{244}pital Calmette, rue du Pr J. Leclercq, 59037 Lille C#{233}dex, France)

Lp(a) lipoprotein in patients with chronic renal failure treated by hemodialysis.

Measurement of lipids, apolipoproteins A-I, A-II, B, C-III, Lp(a) and cholesterol, phospholipids, apo C-III in lipoprotein with and without apolipoprotein B was made in 49 patients (18 women and 31 men; mean age 50 +/- 15 years) undergoing maintenance haemodialysis for chronic renal failure. A group of 49 healthy people, matched for sex and age, acted as controls. In the haemodialysis group, special attention was placed upon the comparison of patients who had evident cardiovascular alterations (n = 17) with the residual group (n = 32). The concentration of apo C-III in apolipoprotein B containing lipoproteins was statistically higher in the patients with arterial disease than in the remaining subjects, whereas the ratio apo C-III from Lp no B/apo C-III from Lp B was decreased. Compared to controls, haemodialysis patients had significantly higher values of triglycerides, apolipoproteins C-III, Lp(a), and apolipoprotein C-III from apolipoprotein B-containing lipoproteins (LpB); in contrast, concentrations of phospholipids and cholesterol from lipoproteins without apolipoprotein B (Lp no B) and apolipoprotein A-II were significantly reduced in patients. Discriminant analysis indicated that the levels of apolipoprotein C-III and apolipoprotein C-III from LpB were the best indicators of deranged lipid transport in patients with chronic renal failure. Our data suggest that chronic haemodialysis patients tend to exhibit qualitative abnormalities of serum apolipoprotein-B triglyceride rich particles containing apolipoprotein C-III or (a).

Lipoprotein abnormalities in chronic haemodialysis patients.

Background. To examine the possible alteration in Lp(a) composition, protein and lipid contents of Lp(a) were determined in 10 haemodialysis patients (HD) matched with 10 controls (C) for apo(a) phenotypes. Methods. All subjects (HD and C) had Lp(a) concentrations greater than 30 mg/dl (mean ± SD : 82.3 ± 41.4 vs 49.3 ± 22.5 mg/dl), a concentration which has been determined to be associated with an elevated cardiovascular risk. Apo(a)-containing particles were isolated by immunoaffinity chromatography using a monoclonal anti-apo(a) antibody. Results. The molar concentrations of lipid and protein constituents of immunoaffinity isolated Lp(a) were expressed as number of moles per mole of apo(a). Lp(a) from HD patients were significantly richer in apo Clll (P<0.05) and triglycerides (TG) (P<0.05), compared to those of controls. Molar ratios of apo B, apo E, cholesterol and phospholipids per apo(a)-containing particles were in the same range in both groups. Conclusion. Lp(a) from HD patients is characterized by an elevated content in TG and apo Clll in comparison with those of controls. Further studies are needed to evaluate in HD patients the contribution of changes in Lp(a) composition towards the metabolism of these particles.

Alteration of the lipid and apolipoprotein contents of lipoprotein (a) in haemodialysis patients

Complex and characteristic abnormalities have been described in chronic renal failure (CRF) patients treated by hemodialysis. Hypertriglyceridemia is the most usual abnormality associated with an increased level of the triglyceride content of very low density lipoproteins (VLDL) which represent a mixture of particles differing in density, size, charge distribution and apolipoprotein (apo) composition1. In normolipidemic subjects these particles contain various combinations of apolipoproteins B, C and E with the major lipoprotein species LpB:C:E characterized by the presence of all three apolipoproteins2. Recent studies tend to establish whether CRF is characterized by a specific apolipoprotein profile3,4b y determining the levels of the different apolipoproteins in this disease.

Quantitative Abnormalities of Lipoprotein Particle in Chronic Hemodialysis Patients

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Lp(a) lipoprotein in patients with chronic renal failure treated by hemodialysis.

Lipoprotein abnormalities in chronic haemodialysis patients.

Alteration of the lipid and apolipoprotein contents of lipoprotein (a) in haemodialysis patients

Quantitative Abnormalities of Lipoprotein Particle in Chronic Hemodialysis Patients