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Ischemic heart disease, serum cholesterol, and apolipoproteins in CAPD
M H Gault1, L Longerich, V Prabhakaran
1Faculty of Medicine, Memorial University of Newfoundland, St. John's, Canada.
Insights
Chronic ambulatory peritoneal dialysis (CAPD) patients exhibit elevated lipids and increased risk of ischemic heart disease. Apolipoprotein B (Apo-B) independently predicts heart disease severity in these patients.
Area of Science:
- Nephrology
- Cardiology
- Clinical Chemistry
Background:
- Chronic ambulatory peritoneal dialysis (CAPD) is a treatment for kidney failure.
- Patients on CAPD often experience dyslipidemia, a risk factor for cardiovascular disease.
- The relationship between CAPD-induced lipid changes and ischemic heart disease (IHD) requires further investigation.
Purpose of the Study:
- To investigate the prevalence and severity of ischemic heart disease (IHD) in patients undergoing chronic ambulatory peritoneal dialysis (CAPD).
- To determine the correlation between specific lipid parameters and the severity of IHD in CAPD patients.
- To identify independent predictors of IHD in this patient population.
Main Methods:
- Retrospective analysis of 31 CAPD patients (mean age 54 years, average CAPD duration 38 months).
- Assessment of lipid profiles including triglycerides, total cholesterol (total-C), LDL-C, HDL-C, and Apolipoprotein B (Apo-B).
- Grading of IHD severity based on patient history, electrocardiogram (EKG), echocardiography, and coronary angiography in a subset of patients.
Main Results:
- Elevated triglycerides, total-C, LDL-C, and Apo-B, with low HDL-C were observed in CAPD patients.
- Apolipoprotein B (Apo-B) and total-C/HDL-C ratio showed significant correlation with IHD severity (p < 0.001).
- Apo-B was identified as the sole independent predictor of heart disease (p = 0.001) via logistic regression.
Conclusions:
- CAPD patients present with significant dyslipidemia and a considerable burden of ischemic heart disease.
- Apolipoprotein B is a strong indicator of IHD severity and an independent predictor of heart disease in CAPD patients.
- The specific contribution of CAPD-induced lipid alterations to the development of IHD remains to be established.
Abstract:
Thirty-one patients, mean age 54 years, had been on chronic ambulatory peritoneal dialysis (CAPD) for an average of 38 months. Mean values (mg/dl) for triglycerides (567), total-C (267), LDL-C (133), and Apo-B (154) were elevated, and HDL-C (30) were low. The low values for total-C/Apo-B and LDL-C/Apo-B suggest an increase in the number of low density lipoprotein (LDL) particles, rather than in the amount of cholesterol per LDL particle. Without knowledge of lipids, ischemic heart disease for the 31 patients was categorized into five grades in the following manner. All patients were graded based on history (angina, myocardial infarction, and bypass surgery), electrocardiogram (EKG), and echocardiography. In addition, five patients underwent coronary angiography, the results of which were considered in their grading. The five grades were assigned as follows: Grade I, no evidence (n = 15); Grade II, angina with EKG ischemia (n = 4); Grade III, myocardial infarction (MI) (n = 1); Grade IV, MI with dyskinesia-akinesia on echo (n = 4); Grade V, severe three vessel disease on angiography, or multiple infarcts, or Grade IV with heart failure (n = 7). Only Apo-B (r = 0.56) and total-C/HDL-C (r = 0.57) correlated with severity of grade, with p less than 0.001. When patients with and without detectable ischemic heart disease were compared by stepwise logistic regression, Apo-B was the only variable that independently predicted heart disease (p = 0.001). However, contribution of the lipid changes induced by CAPD has not been established.