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HDL and chronic kidney disease
Chiara Pavanello1, Alice Ossoli1
1Centro E. Grossi Paoletti, Dipartimento di Scienze Farmacologiche e Biomolecolari, Università degli Studi di Milano, Milan, Italy.
Insights
Low high-density lipoprotein cholesterol (HDL-C) is linked to chronic kidney disease (CKD) progression. HDL dysfunction in CKD patients may damage kidneys, suggesting HDL targeting as a potential therapeutic strategy.
Area of Science:
- Lipid metabolism
- Nephrology
- Cardiovascular research
Background:
- Low high-density lipoprotein cholesterol (HDL-C) is a hallmark of dyslipidemia in chronic kidney disease (CKD).
- In CKD, HDL particles undergo structural and functional changes, losing atheroprotective properties and potentially becoming detrimental.
- Reduced HDL-C levels are uniquely associated with CKD progression.
Purpose of the Study:
- To review alterations in HDL structure and function in CKD.
- To explore the link between genetic HDL metabolism defects and kidney dysfunction.
- To discuss targeting the HDL system as a strategy to slow CKD progression.
Main Methods:
- Literature review of studies on HDL metabolism in CKD.
- Analysis of genetic mutations affecting HDL components (e.g., APOA1, APOE, APOL, LCAT).
- Examination of LCAT deficiency as a model for CKD-associated lipid abnormalities.
Main Results:
- CKD is associated with dysfunctional HDL particles that lose protective functions.
- Genetic defects in HDL metabolism, particularly LCAT deficiency, mirror lipid abnormalities seen in CKD.
- Reduced HDL-C levels are a significant indicator of CKD progression.
Conclusions:
- HDL dysfunction plays a critical role in CKD pathogenesis and progression.
- Genetic factors influencing HDL metabolism are implicated in kidney disease.
- Modulating the HDL system presents a potential therapeutic avenue for managing CKD.
Abstract:
Low HDL-cholesterol (HDL-C) concentrations are a typical trait of the dyslipidemia associated with chronic kidney disease (CKD). In this condition, plasma HDLs are characterized by alterations in structure and function, and these particles can lose their atheroprotective functions, e.g., the ability to promote cholesterol efflux from peripheral cells, anti-oxidant and anti-inflammatory proprieties and they can even become dysfunctional, i.e., exactly damaging. The reduction in plasma HDL-C levels appears to be the only lipid alteration clearly linked to the progression of renal disease in CKD patients. The association between the HDL system and CKD development and progression is also supported by the presence of genetic kidney alterations linked to HDL metabolism, including mutations in the APOA1, APOE, APOL and LCAT genes. Among these, renal disease associated with LCAT deficiency is well characterized and lipid abnormalities detected in LCAT deficiency carriers mirror the ones observed in CKD patients, being present also in acquired LCAT deficiency. This review summarizes the major alterations in HDL structure and function in CKD and how genetic alterations in HDL metabolism can be linked to kidney dysfunction. Finally, the possibility of targeting the HDL system as possible strategy to slow CKD progression is reviewed.
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