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High serum lipoprotein(a) concentrations in uremic patients treated with continuous ambulatory peritoneal dialysis
T Shoji1, Y Nishizawa, H Nishitani
1Second Department of Internal Medicine, Osaka City University Medical School, Japan.
Insights
Uremic patients on continuous ambulatory peritoneal dialysis (CAPD) have significantly higher serum lipoprotein(a) [Lp(a)] levels than those on hemodialysis (HD) or normal controls. High Lp(a) may increase ischemic heart disease risk in CAPD patients.
Area of Science:
- Nephrology
- Cardiovascular Medicine
- Clinical Chemistry
Background:
- Elevated serum lipoprotein(a) [Lp(a)] is a risk factor for cardiovascular disease.
- Uremic patients, particularly those on dialysis, often exhibit dyslipidemia and increased cardiovascular risk.
Purpose of the Study:
- To compare serum Lp(a) concentrations in patients undergoing continuous ambulatory peritoneal dialysis (CAPD) with those on hemodialysis (HD) and healthy controls.
- To investigate the relationship between Lp(a) levels, apolipoprotein B, and ischemic heart disease (IHD) in CAPD patients.
Main Methods:
- Serum Lp(a) levels were measured in 50 CAPD patients, 29 HD patients, and 62 normal controls.
- Statistical analyses included Kruskal-Wallis test, chi-square test, and Mann-Whitney U-test.
- Correlations between Lp(a) and apolipoprotein B were assessed.
Main Results:
- Median Lp(a) levels were significantly higher in CAPD patients (47.9 mg/dl) compared to HD patients (25.2 mg/dl) and controls (11.7 mg/dl) (p < 0.0001).
- A higher prevalence of elevated Lp(a) (>30 mg/dl) was observed in CAPD (70%) and HD (41%) patients versus controls (15%) (p < 0.01).
- CAPD patients with IHD had significantly higher median Lp(a) levels (67.4 mg/dl) than those without IHD (40.9 mg/dl) (p < 0.01).
Conclusions:
- Continuous ambulatory peritoneal dialysis is associated with significantly higher serum Lp(a) levels compared to hemodialysis and normal controls.
- Elevated Lp(a) may contribute to an increased risk of ischemic heart disease in CAPD patients.
- A potential relationship between Lp(a) and apolipoprotein B metabolism exists in CAPD patients.
Abstract:
We measured serum lipoprotein(a) [Lp (a)] concentrations in 50 uremic patients treated on continuous ambulatory peritoneal dialysis (CAPD) and compared them with those in 29 uremic patients on hemodialysis (HD) and those in 62 normal controls. The median values were 47.9 mg/dl in CAPD patients, 25.2 mg/dl in HD patients, and 11.7 mg/dl in controls, respectively. These differences were statistically significant when assessed by Kruskal-Wallis test (p < 0.0001). Thirty-five out of 50 patients on CAPD (70%) and 12 out of 29 patients on HD (41%) had Lp(a) concentrations above 30 mg/dl, whereas these high values were observed in only 15% of normal controls. This difference in prevalence of high Lp(a) was also significant by 2 x 3 chi-square test (p < 0.01). There was a significant positive correlation between Lp(a) and apolipoprotein B (r = 0.517, p < 0.0001). In CAPD patients, 9 with ischemic heart disease had a significantly higher median Lp(a) than those without it (67.4 vs 40.9 mg/dl, p < 0.01 by Mann-Whitney U-test). These results suggest that high levels of serum Lp(a) might contribute to an increased risk for ischemic heart disease in CAPD patients, and that there may be a relationship between Lp(a) and apolipoprotein B metabolism in CAPD patients.