Lipoprotein(a) in chronic renal disease

Atherosclerotic vascular disease is a major cause of morbidity and mortality in patients with chronic renal disease and in renal transplant recipients. Epidemiological studies have shown that a high lipoprotein(a) [Lp(a)] concentration in the general population is an independent risk factor for the development of atherosclerotic complications, such as coronary heart disease. Interestingly, plasma levels of Lp(a) have often been reported to be elevated in chronic renal disease. Recent studies have found no difference in the isoform distribution of apo(a) between healthy subjects and patients with renal disease, suggesting that factors other than genetic differences are involved in the high levels of Lp(a) reported in chronic renal disease. In particular, patients with major losses of protein in urine and/or dialysate, such as nephrotic patients and those treated with continuous ambulatory peritoneal dialysis, have been reported to have elevated plasma Lp(a) levels. The results regarding plasma Lp(a) levels in hemodialysis patients are conflicting, although recent evidence suggests that serum albumin levels are of importance for the prevailing Lp(a) levels. In renal transplant recipients conflicting data regarding plasma Lp(a) levels have also been reported, a finding that may be attributable to posttransplant urinary protein losses and/or different immunosuppressive regimens. The importance of Lp(a) as a risk factor for atherosclerotic disease in patients with chronic renal failure remains to established, and prospective evaluations of the role of Lp(a) are necessary.