Importance of high-density lipoprotein quality: evidence from chronic kidney disease

Area of Science:

• Cardiovascular Medicine
• Nephrology
• Biochemistry

Background:

• Chronic kidney disease (CKD) is associated with a high risk of cardiovascular disease (CVD).
• Lipid-lowering therapies show benefits in mild to moderate CKD but limited efficacy in advanced stages.
• Residual cardiovascular risk persists in CKD patients despite statin therapy.

Purpose of the Study:

• To review advances in understanding the link between high-density lipoprotein (HDL) function and CVD in CKD patients.
• To explore how HDL quantity and functionality contribute to residual cardiovascular risk in CKD.

Main Methods:

• Review of large randomized statin trials and meta-analyses.
• Analysis of studies examining HDL composition, metabolism, and function in CKD.
• Examination of cholesterol acceptor function and pro-inflammatory effects of HDL in CKD.

Main Results:

• Lipid-lowering therapy benefits patients with mild to moderate CKD, but not those with advanced CKD on dialysis.
• Patients with advanced CKD exhibit exaggerated residual cardiovascular risk.
• CKD alters HDL levels, composition, and functionality, including impaired cholesterol acceptance and pro-inflammatory properties.
• These HDL abnormalities in CKD may involve distinct mechanistic pathways.

Conclusions:

• CKD-induced changes in HDL composition, metabolism, and function contribute to excess CVD risk.
• Dysfunctional HDL in CKD presents potential novel therapeutic targets for intervention.
• Further research into HDL's role in CKD is warranted to mitigate cardiovascular events.