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Factors associated with lipoprotein(a) in chronic kidney disease
Katrin Uhlig1, Shin-Ru Wang, Gerald J Beck
1Department of Medicine, Division of Nephrology, Tufts-New England Medical Center, Boston, MA 02111, USA. kuhlig@tufts-nemc.org
Insights
Lipoprotein(a) [Lp(a)] levels in chronic kidney disease (CKD) are not linked to glomerular filtration rate (GFR). Instead, Lp(a) is associated with apoprotein(a) [apo(a)] size, race, proteinuria, C-reactive protein (CRP), and triglycerides.
Area of Science:
- Nephrology
- Cardiovascular Medicine
- Clinical Chemistry
Background:
- Lipoprotein(a) [Lp(a)] levels in chronic kidney disease (CKD) are not fully understood.
- Investigating the relationship between Lp(a) and reduced glomerular filtration rate (GFR) is crucial.
- Other CKD-related factors may influence Lp(a) levels.
Purpose of the Study:
- To examine the association between Lp(a) levels and GFR in CKD patients.
- To explore the role of apoprotein(a) [apo(a)] isoform size, race, proteinuria, serum albumin, C-reactive protein (CRP), and lipids.
- To identify factors associated with elevated Lp(a) in CKD.
Main Methods:
- Serum samples from 804 CKD patients (GFR 13-55 mL/min/1.73 m2) were analyzed.
- Measurements included Lp(a) and apo(a) isoforms.
- Cross-sectional associations were assessed using univariate and multivariate linear regression.
Main Results:
- Lp(a) levels were significantly higher in Black individuals compared to White individuals (97.5 vs 28.1 nmol/L).
- Individuals with low-molecular-weight apo(a) isoforms had higher Lp(a) levels than those with high-molecular-weight isoforms (57.5 vs 21.3 nmol/L).
- Lp(a) levels were not associated with GFR. Independent associations with higher Lp(a) included low-molecular-weight apo(a), Black race, higher proteinuria, higher CRP, and higher triglycerides.
Conclusions:
- In CKD stages 3-4, GFR is not associated with Lp(a) levels.
- Factors such as apo(a) isoform size, race, proteinuria, CRP, and triglyceride levels are associated with Lp(a) levels in CKD.
- These findings highlight genetic and CKD-specific factors influencing Lp(a) beyond GFR.
Background:
It is unclear whether lipoprotein(a) (Lp[a]) levels in patients with chronic kidney disease (CKD) are elevated as a result of reduced glomerular filtration rate (GFR) or other factors associated with CKD. The goal of this study is to describe the association of Lp(a) level with GFR in the context of apoprotein(a) (apo[a]) isoform size, race, and other kidney disease-related factors, such as proteinuria, serum albumin level, C-reactive protein (CRP) level, and serum lipid levels.
Methods:
Lp(a) and apo(a) isoforms were measured in serum samples obtained at baseline from 804 participants in the Modification of Diet in Renal Disease study (GFR range, 13 to 55 mL/min/1.73 m2). The cross-sectional association between Lp(a) level and GFR, apo(a) isoform size, race, and other variables was analyzed in univariate and multivariate linear regression.
Results:
Median Lp(a) level was greater in blacks than whites (97.5 versus 28.1 nmol/L; P < 0.001). Those with a low-molecular-weight apo(a) isoform size had greater Lp(a) levels than those with a high-molecular-weight apo(a) isoform size (57.5 versus 21.3 nmol/L; P < 0.001). Lp(a) level was not associated with GFR. Low-molecular-weight apo(a), black race, and greater levels of proteinuria, CRP, and triglycerides were independently associated with greater Lp(a) levels.
Conclusion:
In this population with CKD stages 3 to 4, GFR was not associated with Lp(a) level, whereas other factors related to CKD, such as proteinuria, CRP level, and triglyceride level, as well as genetic factors such as apo(a) isoform size and race, were associated with Lp(a) level.
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