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Updated: Feb 10, 2026
Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
HDL functionality and cardiovascular outcome among nondialysis chronic kidney disease patients
Kathrin Untersteller1, Sabine Meissl2, Markus Trieb2,3
1Internal Medicine IV-Nephrology and Hypertension, Saarland University Medical Center, Homburg, Germany.
Insights
In chronic kidney disease (CKD), high-density lipoprotein (HDL) abnormalities do not independently predict cardiovascular events. This study found no independent association between HDL levels, composition, or function and cardiovascular outcomes in CKD patients.
Area of Science:
- Nephrology
- Cardiology
- Biochemistry
Background:
- Cardiovascular disease (CVD) is a major cause of death in chronic kidney disease (CKD) patients.
- High-density lipoprotein (HDL) function and composition are altered in CKD.
- The independent role of abnormal HDL in predicting cardiovascular events in CKD remains unclear.
Purpose of the Study:
- To investigate whether HDL cholesterol, composition, and functionality predict cardiovascular outcomes in non-dialysis CKD patients.
- To assess the predictive value of HDL-associated serum amyloid A (SAA), paraoxonase, and lipoprotein-associated phospholipase A2 (Lp-PLA2) activity.
- To evaluate the antioxidative capacity of apoB-depleted serum.
Main Methods:
- Prospective cohort study of 526 non-dialysis CKD patients (CARE FOR HOMe study).
- Measurements included HDL cholesterol, HDL-SAA content, paraoxonase and Lp-PLA2 activities, and serum antioxidative capacity.
- Follow-up for a mean of 5.1 years for a composite endpoint of atherosclerotic cardiovascular events and all-cause mortality.
Main Results:
- Univariate analysis showed lower HDL cholesterol, higher HDL-SAA, and lower paraoxonase activity predicted cardiovascular outcome.
- These associations were attenuated after adjusting for traditional risk factors and C-reactive protein.
- Lp-PLA2 activity and antioxidative capacity did not predict outcomes.
Conclusions:
- HDL cholesterol quantity, HDL composition (SAA), and HDL function (paraoxonase activity) do not independently predict cardiovascular outcomes in non-dialysis CKD patients.
- The predictive value of these HDL parameters is likely confounded by traditional cardiovascular and renal risk factors.
- Further research is needed to understand the complex relationship between HDL and CVD in the CKD population.
Abstract:
CVD remains the leading cause of morbidity and mortality in patients with chronic kidney disease (CKD). CKD profoundly affects HDL composition and functionality, but whether abnormal HDL independently contributes to cardiovascular events in CKD patients remains elusive. In the present study, we assessed whether compositional and functional properties of HDL predict cardiovascular outcome among 526 nondialysis CKD patients who participate in the CARE FOR HOMe study. We measured HDL cholesterol, the content of HDL-associated proinflammatory serum amyloid A (SAA), and activities of the HDL enzymes paraoxonase and lipoprotein-associated phospholipase A2 (Lp-PLA2). In addition, we assessed the antioxidative activity of apoB-depleted serum. During a mean follow-up of 5.1 ± 2.1 years, 153 patients reached the predefined primary endpoint, a composite of atherosclerotic cardiovascular events including cardiovascular mortality and death of any cause. In univariate Cox regression analyses, lower HDL-cholesterol levels, higher HDL-associated SAA content, and lower paraoxonase activity predicted cardiovascular outcome, while Lp-PLA2 activity and antioxidative capacity did not. HDL-cholesterol and HDL-paraoxonase activity lost their association with cardiovascular outcome after adjustment for traditional cardiovascular and renal risk factors, while SAA lost its association after further adjustment for C-reactive protein. In conclusion, our data suggest that neither HDL quantity nor HDL composition or function independently predict cardiovascular outcome among nondialysis CKD patients.
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