BACKGROUND: The high mortality rate in end-stage renal disease has engendered interest in nontraditional atherosclerotic cardiovascular disease (ASCVD) risk factors that are more prevalent in end-stage renal disease, such as elevated lipoprotein(a) [Lp(a)] levels. Previous studies suggest that high Lp(a) levels and small apolipoprotein(a) [apo(a)] isoform size are associated with ASCVD, but none have investigated the relationship between Lp(a) level, apo(a) size, and mortality. METHODS AND RESULTS: An inception cohort of 864 incident dialysis patients was followed prospectively. Lp(a) was measured by an apo(a) size-independent ELISA and apo(a) size by Western blot after SDS-agarose gel electrophoresis. Comorbid conditions were determined by medical record review. Time to death was ascertained through dialysis clinic and Health Care Financing Administration follow-up. Survival analyses were performed with adjustment for baseline demographic, comorbid conditions, albumin, and lipids. Median follow-up was 33.7 months, with 346 deaths, 162 transplantations, and 10 losses to follow-up during 1999 person-years of follow-up. Cox regression analysis showed no association between Lp(a) level and mortality. However, an association between small apo(a) isoform size and mortality was found (hazard ratio, 1.36; P=0.004) after adjusting for age, race, sex, comorbidity score, cause of renal disease, and congestive heart failure. The association was somewhat lower in white patients (hazard ratio 1.34; P=0.019) than in black patients (1.69; P=0.04). No interaction by age, race, sex, diabetes, ASCVD, or Lp(a) level was present. CONCLUSIONS: Small apo(a) size, but not Lp(a) level, independently predicts total mortality risk in dialysis patients.
BACKGROUND: The high mortality rate in end-stage renal disease has engendered interest in nontraditional atherosclerotic cardiovascular disease (ASCVD) risk factors that are more prevalent in end-stage renal disease, such as elevated lipoprotein(a) [Lp(a)] levels. Previous studies suggest that high Lp(a) levels and small apolipoprotein(a) [apo(a)] isoform size are associated with ASCVD, but none have investigated the relationship between Lp(a) level, apo(a) size, and mortality. METHODS AND RESULTS: An inception cohort of 864 incident dialysis patients was followed prospectively. Lp(a) was measured by an apo(a) size-independent ELISA and apo(a) size by Western blot after SDS-agarose gel electrophoresis. Comorbid conditions were determined by medical record review. Time to death was ascertained through dialysis clinic and Health Care Financing Administration follow-up. Survival analyses were performed with adjustment for baseline demographic, comorbid conditions, albumin, and lipids. Median follow-up was 33.7 months, with 346 deaths, 162 transplantations, and 10 losses to follow-up during 1999 person-years of follow-up. Cox regression analysis showed no association between Lp(a) level and mortality. However, an association between small apo(a) isoform size and mortality was found (hazard ratio, 1.36; P=0.004) after adjusting for age, race, sex, comorbidity score, cause of renal disease, and congestive heart failure. The association was somewhat lower in white patients (hazard ratio 1.34; P=0.019) than in black patients (1.69; P=0.04). No interaction by age, race, sex, diabetes, ASCVD, or Lp(a) level was present. CONCLUSIONS: Small apo(a) size, but not Lp(a) level, independently predicts total mortality risk in dialysis patients.
Authors: Lygeri P Soubassi; Theodore C Chiras; Emmanuel D Papadakis; George D Poulos; Dimitrios I Chaniotis; Ioannis P Tsapakidis; Sofia P Soubassi; Stylianos N Zerefos; Nikolaos S Zerefos; Dimitrios A Valis Journal: Int Urol Nephrol Date: 2006 Impact factor: 2.370
Authors: Wensheng Lu; Yu-Ching Cheng; Keping Chen; Hong Wang; Glenn S Gerhard; Christopher D Still; Xin Chu; Rongze Yang; Ankita Parihar; Jeffrey R O'Connell; Toni I Pollin; Eduardo Angles-Cano; Michael J Quon; Braxton D Mitchell; Alan R Shuldiner; Mao Fu Journal: Hum Mol Genet Date: 2015-01-09 Impact factor: 6.150
Authors: J Craig Longenecker; Josef Coresh; Michael J Klag; Neil R Powe; Nancy E Fink; Santica M Marcovina Journal: Clin Chim Acta Date: 2008-07-18 Impact factor: 3.786
Authors: Jill Rubin; Han Jo Kim; Thomas A Pearson; Steve Holleran; Lars Berglund; Rajasekhar Ramakrishnan Journal: Atherosclerosis Date: 2008-03-04 Impact factor: 5.162