Abstract

CEREZO ARIAS, I. et al. Apolipoprotein A and B as outcome predictors of advanced chronic kidney disease patients not yet on dialysis. Nefrología (Madr.) [online]. 2009, vol.29, n.6, pp.540-547. ISSN 1989-2284.

Dyslipidaemia is a well-established risk factor for cardiovascular diseases in the general population. However, this association is not observed in chronic kidney disease (CKD) patients. This study examines the association between lipid levels, including apolipoproteins A-I and B concentrations, and all-cause mortality or the development of new cardiovascular events in advanced CKD patients. This observational prospective historical study included 331 patients with CKD stage 4 or 5 not yet on dialysis. In addition to conventional clinical and biochemical data, total cholesterol, triglycerides, HDL, LDL, apolipoprotein A-I (apo A) and B (apo B) plasma concentrations were measured. Cox proportional hazard models were adjusted for age, sex, comorbidity index, residual renal function, serum albumin, C-reactive protein levels, and treatment with statins. The median follow-up time was 985 days, and during this period 105 patients died and 54 patients had a new cardiovascular event. In fully-adjusted fixed-covariate Cox models, the hazard ratio for each 10mg/dl increase of apo A concentration was 0.915 (C.I. 95% 0.844 to 0.992; p = 0,031). Patients with an apo A/apo B ratio in the upper tertile (i.e. >1.42) had a better survival rate than the rest of the study patients (hazard ratio = 0.592, C.I. 95% 0.368 to 0.953, p < 0.05). None of the study lipid parameters were associated with new cardiovascular events in the adjusted models. In conclusion, apo A concentrations and high apo A/apo B ratios added independent predictive information about survival of CKD patients not yet on dialysis.

Keywords : Apolipoprotein A; Apolipoprotein B; Chronic kidney disease; Lipids; Mortality.

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