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Lipid parameters including Lp(a) in hemodialysis patients
M Elisaf1, H Bairaktari, C Tzallas
1Department of Internal Medicine, University of Ioannina, Greece.
Insights
Chronic hemodialysis patients exhibit significantly higher lipoprotein(a) levels, a key risk factor for atherosclerosis. This elevation persists even when other lipid profiles are normalized, highlighting Lp(a) as a critical concern in hemodialysis care.
Area of Science:
- Nephrology
- Cardiovascular Medicine
- Clinical Chemistry
Background:
- Chronic hemodialysis (CHD) patients face a high burden of atherosclerotic disease.
- Dyslipidemia is a significant contributing factor to atherosclerosis in this population.
- Elevated lipoprotein(a) [Lp(a)] levels are increasingly recognized as a potent risk marker for atherosclerosis, particularly in uremic patients.
Purpose of the Study:
- To determine and compare serum Lp(a) levels in patients undergoing chronic hemodialysis versus healthy controls.
- To investigate the prevalence of elevated Lp(a) concentrations in CHD patients.
- To explore potential correlations between Lp(a) levels and patient demographics or dialysis duration.
Main Methods:
- A cohort of 151 chronic hemodialysis patients and 84 age- and sex-matched healthy controls were enrolled.
- Serum lipid parameters, including Lp(a), were measured in all participants.
- Statistical analysis, including the Mann-Whitney test, was used to compare Lp(a) levels between groups.
Main Results:
- Median serum Lp(a) concentration was significantly higher in CHD patients (13 mg/dL) compared to controls (6.5 mg/dL) (p < 0.001).
- The prevalence of Lp(a) levels above 25 mg/dL was substantially greater in CHD patients (30%) than in controls (8%) (p < 0.001).
- Elevated Lp(a) levels in CHD patients were observed independently of other fasting lipid levels, age, or duration of hemodialysis.
Conclusions:
- Chronic hemodialysis patients demonstrate significantly elevated serum Lp(a) levels, indicating an increased atherosclerotic risk.
- Lipoprotein(a) is a critical dyslipidemic factor in CHD patients, independent of other lipid parameters.
- Routine monitoring of Lp(a) may be warranted in patients undergoing chronic hemodialysis to manage cardiovascular risk.
Abstract:
Chronic hemodialysis (CHD) patients have a high incidence and prevalence of atherosclerotic disease which may be related to numerous atherosclerotic risk factors. Among them dyslipidemia plays a significant role. Elevated Lp(a) levels, which are strongly associated with atherosclerosis, have been reported recently in uremic patients. The aim of our study was the determination of the levels of lipid parameters including Lp(a) in 151 CHD patients (76 male) aged 57 (12-81) years, who were on hemodialysis for a mean of 44.3 (range 1 to 189) months. Eighty-four normal individuals age and sex matched were used as controls. The median serum Lp(a) concentration in hemodialysis patients was 13 mg/dL compared with 6.5 mg/dL in healthy controls, p < 0.001 by distribution-free Mann-Whitney test. The prevalence of subjects with Lp(a) levels above 25 mg/dL was significantly higher in CHD patients compared to normal subjects (30% vs. 8%, p < 0.001). Even if CHD patients were matched for fasting lipid levels, they showed Lp(a) levels significantly higher than controls. No significant correlation was found between Lp(a) levels and either the age of the patients or the duration of hemodialysis. The etiology of primary renal disease did not influence the Lp(a) levels.