High density lipoprotein and kidney dysfunction among post kidney transplant patients (original) (raw)
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Are lipid-dependent indicators of cardiovascular risk affected by renal transplantation?
Clinical Transplantation, 2000
Hyperlipoproteinemia has been reported to frequently occur in kidney transplanted patients, thus possibly explaining, at least in part, the increased incidence of cardiovascular disease in this population. To evaluate the impact of renal transplantation (Tx), and related immunosuppressive therapy, on plasma lipoprotein and Lp(a) profile, we selected a cohort of kidney transplanted patients (36 M/14 F; age 33.8 9 12.0 yr, range 13 -62) lacking significant causes of hyperlipidemia. All patients received a triple immunosuppressive regimen and showed a stable renal function after Tx (plasma creatinine: 1.36 9 0.35 mg/dL). One year after Tx, we found a significant increase of total cholesterol (TC), LDL, HDL, ApoB and ApoA-I (p B 0.005), while plasma triglyceride levels remained unmodified. Lp(a) plasma levels after Tx were within the normal range and displayed a significant inverse relationship with apo(a) size. Noteworthy, LDL/HDL ratio and ApoB/ ApoA-I ratio in kidney transplanted patients were almost superimposable with those of normal controls. Specifically, LDL/HDL ratio significantly decreased in 64% of patients after Tx, due to a prevalent increase of HDL, and was associated with a moderate amelioration of plasma TG. In a multiple linear regression model, post-Tx HDL level was significantly related to recipient's age, gender, BMI and cyclosporine (CyA) trough levels (Adj-R2 = 0.35, p = 0.0002), with gender and CyA trough levels being the better predictors of HDL. In conclusion, immunosuppressive regimens, in themselves, do not appear to significantly increase the atherogenic risk related to lipoproteins. Rather, other factors can affect the lipoprotein profile and its vascular effects in renal transplant recipients.
Hyperlipidemia and cardiovascular diseases in patients with transplanted kidney
Atherosclerosis, 2018
The aim of the study was to assess the differences of lipidogram parameters between diabetes mellitus (DM) group and non-diabetic group of middle aged Lithuanian adults participating in Lithuanian High Cardiovascular Risk primary prevention programme. Methods: During the period of 2009-2016 a total of 92,373 people (58.4% women and 41.6% men) were evaluated. This study included men from 40 to 54 years of age and women from 50 to 64 without overt cardiovascular disease. Subjects were divided into two groups: diabetes mellitus and nondiabetic subjects. Their lipid profile was assessed and used for further statistical analysis. Results: Subjects with diabetes mellitus had higher mean total cholesterol (6.20±1.30mmol/L vs. 6.07±1.20mmol/L, p<0.001), LDL cholesterol (3.91±1.11mmol/L vs 3.87±1.07mmol/L, p<0.001), triglycerides (2.12±1.73mmol/L vs 1.52±1.05mmol/L, p<0.001) as well as lower HDL cholesterol levels (1.41±0.43mmol/L vs 1.56±0.46mmol/L, p<0.001) than a group without diabetes mellitus. 82.7% of subjects with diabetes mellitus had increased level of total cholesterol (>5 mmol/l) compared to 81.6% in control group (p¼0.009), higher levels of triglycerides (>1.7 mmol/l) (50.1% vs. 28.0%, p<0.001) and lower levels of HDL-C (<1.2 mmol/l for women and <1 mmol/l for men) (23.6% vs. 12.5%, p<0.001). There was no statistically significant difference between groups when we compared percentage of subjects whose LDL-C value was above the normal (LDL-C <3mmol/L) range (79.50% vs 79.20%, p¼0.571). Conclusions: Middle aged Lithuanian adults with diabetes mellitus are associated with more atherogenic lipid profile. However, percentage of subjects with LDL-C concentration above normal range did not differ between groups. Aim: The general objective of IBERICAN (IB) is to establish the prevalence and incidence of cardiovascular risk factors and events in Spain.The objective of this study was to determine the characteristics of dyslipidemia (DL) and its association with different vascular risk factor (VRF). Methods: IB is an observational, multicentric study where individuals that attend primary care (PC) centers in Spain,18e85 years. The final cohort will have a follow up of 5 years and the expected final sample will be 7000. In the analyzed (n ¼ 6000), the presence or absence of DL and atherogenic DL was analyzed according to sex, age and the presence of other VRF.
Prognostic Associations Between Lipid Markers and Outcomes in Kidney Transplant Recipients
American Journal of Kidney Diseases, 2006
Hyperlipidemia is highly prevalent in kidney transplant recipients, but the prognostic significance for mortality and allograft survival in these patients has not been established sufficiently. We prospectively enrolled 733 kidney transplant recipients between 1996 and 1998. Clinical information was collected and blood was drawn for laboratory evaluation. Information on the previous transplantation procedures and organ donor were obtained from the Eurotransplant Foundation database. We used the Austrian Dialysis and Transplantation Registry for follow-up. Using multivariate proportional hazard regression, independent relations of fasting plasma triglyceride (TG), total cholesterol (TC), high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol levels to risk for death from any cause and risk for kidney allograft loss were examined. During a median follow-up of 6.1 years, 154 patients died and 260 kidney allografts were lost. After careful multivariate adjustment, there were no significant associations between TG and TC levels and patient mortality. Patients in the highest quartile of TG and TC levels had no difference in risks for mortality compared with patients in the lowest quartile of these parameters (hazards ratio, 0.81; 95% confidence interval, 0.51 to 1.28; hazards ratio, 0.68; 95% confidence interval, 0.42 to 1.10, respectively). Similarly, no associations were found with allograft loss. Further analysis of associations between high-density lipoprotein cholesterol or low-density lipoprotein cholesterol categories and patient mortality or kidney allograft loss did not show associations. Elevated levels of TC or its subfractions and elevated TG levels are not associated with increased risk for patient mortality or allograft loss in these kidney transplant recipients.
Kidney international, 2016
Available experimental evidence suggests a role for high-density lipoprotein cholesterol (HDL-C) in incident chronic kidney disease (CKD) and its progression. However, clinical studies are inconsistent. We therefore built a cohort of 1,943,682 male US veterans and used survival models to examine the association between HDL-C and risks of incident CKD or CKD progression (doubling of serum creatinine, eGFR decline of 30% or more), or a composite outcome of ESRD, dialysis, or renal transplantation. Models were adjusted for demographics, comorbid conditions, eGFR, body mass index, lipid parameters, and statin use over a median follow-up of 9 years. Compared to those with HDL-C of 40 mg/dl or more, low HDL-C (under 30 mg/dl) was associated with increased risk of incident eGFR under 60 ml/min/1.73 m(2) (hazard ratio: 1.18; confidence interval: 1.17-1.19) and risk of incident CKD (1.20; 1.18-1.22). Adjusted models demonstrate an association between low HDL-C and doubling of serum creatinin...
Increased low density lipoprotein oxidation in stable kidney transplant recipients
Kidney International, 1996
Increased low density lipoprotein oxidation in stable kidney transplant recipients. We studied factors that may add to the high risk of atherosclerosis in kidney transplant recipients. Plasma lipoprotein concentrations and parameters of low density lipoprotein (LDL) oxidation were determined in 19 clinically stable kidney recipients and 19 healthy controls. Plasma triglycerides and total cholesterol were increased in the patients. High density lipoprotein-cholesterol (HDL-c) was in the normal range. The mean LDL diameter was smaller in patients than in controls (236.5 7.3 A vs. 247.8 11.6 A, P < 0.002), which was due to a higher frequency of the LDL subclass pattern B in the patients than in controls (58% vs. 28%). The lag time of copper-induced in vitro LDL oxidation was shorter in patients than in controls (101 23mm vs. 148 81 mm, = 0.02). The titer and concentration of autoantihodies against malondialdehyde-modified (MDA-LDL) determined by ELISA were higher in the patients than in the controls. This difference was found in both IgG (titer + 9%, concentration + 75%; P < 0.05) and 1gM (titer + 35%, concentration + 102%; P < 0.001). Based on these results, we propose that there is in vitro and in viva evidence of enhanced LDL oxidation in patients post-renal transplantation. This might represent one cause for the clinical finding of advanced atherosclerosis in these patients. Cardiovascular atherosclerosis is frequently found in patients with chronic renal insufficiency. If atherosclerosis is present before transplantation, it continues to progress after renal transplantation [1]. Several factors may contribute to the progression of the atherosclerosis [21. Before transplantation, most patients are suffering from chronic renal failure, which is associated with a high incidence of atherosclerosis [3, 4]. After transplantation, there is an increased prevalence of the well-established risk factors, hypertension [5, 61 and hyperlipidemia [7-9]. Besides increased plasma lipoprotein concentrations, alterations in the composition [10] and susceptibility for oxidation [11] of the lipoproteins may also play a role in the atherosclerosis in kidney transplantation patients. Chemical modification of LDL, including oxidation, probably precedes the uptake of LDL by macrophages and the accumulation of cholesterol in the arterial wall [12, 13]. The presence of oxidatively modified LDL in atherosclerotic lesions supports this hypothesis [14-16]. The susceptibility of LDL for oxidation can be determined in vitro [17]. As a measure
Nephrology Dialysis Transplantation
Background The cholesterol content of circulating triglyceride-rich lipoproteins is characterized as remnant cholesterol, although little is known about its role in the development of cardiovascular disease (CVD) outcomes, all-cause mortality or transplant failure in kidney transplant recipients (KTRs). Our primary aim was to investigate the prospective association of remnant cholesterol and the risk of CVD events in renal transplant recipients with secondary aims evaluating remnant cholesterol and renal graft failure and all-cause mortality among participants in the Folic Acid for Vascular Outcome Reduction in Transplantation (FAVORIT) trial. Methods Among 4110 enrolled participants, 98 were excluded for missing baseline remnant cholesterol levels and covariates. Nonfasting remnant cholesterol levels were calculated based on the lipid profiles in 3812 FAVORIT trial participants at randomization. A Wilcoxon-type test for trend was used to compare baseline characteristics across remn...
HDL Cholesterol Is Not Associated with Lower Mortality in Patients with Kidney Dysfunction
Journal of the American Society of Nephrology, 2014
In the general population, HDL cholesterol (HDL-C) is associated with reduced cardiovascular events. However, recent experimental data suggest that the vascular effects of HDL can be heterogeneous. We examined the association of HDL-C with all-cause and cardiovascular mortality in the Ludwigshafen Risk and Cardiovascular Health study comprising 3307 patients undergoing coronary angiography. Patients were followed for a median of 9.9 years. Estimated GFR (eGFR) was calculated using the Chronic Kidney Disease Epidemiology Collaboration eGFR creatinine-cystatin C (eGFR creat-cys) equation. The effect of increasing HDL-C serum levels was assessed using Cox proportional hazard models. In participants with normal kidney function (eGFR.90 ml/min per 1.73 m 2), higher HDL-C was associated with reduced risk of all-cause and cardiovascular mortality and coronary artery disease severity (hazard ratio [HR], 0.51, 95% confidence interval [95% CI], 0.26-0.92 [P=0.03]; HR, 0.30, 95% CI, 0.13-0.73 [P=0.01]). Conversely, in patients with mild (eGFR=60-89 ml/min per 1.73 m 2) and more advanced reduced kidney function (eGFR,60 ml/min per 1.73 m 2), higher HDL-C did not associate with lower risk for mortality (eGFR=60-89 ml/min per 1.