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The effect of change of renal replacement therapy on serum lipoprotein (a) concentration
M Misra1, A T Webb, D A Reaveley
1Department of Nephrology, Charing Cross Hospital, London, U.K.
Insights
Renal replacement therapy (RRT) significantly impacts lipoprotein (a) [Lp(a)] levels. Continuous ambulatory peritoneal dialysis (CAPD) is associated with the highest Lp(a) levels, while transplantation or switching to hemodialysis (HD) reduces them.
Area of Science:
- Nephrology
- Cardiovascular Medicine
- Clinical Chemistry
Background:
- Elevated Lipoprotein (a) [Lp(a)] is an independent risk factor for atherosclerosis.
- Patients undergoing renal replacement therapy (RRT) often exhibit higher Lp(a) levels.
- The influence of RRT modality changes on lipid profiles and Lp(a) requires investigation.
Purpose of the Study:
- To investigate the effect of changes in RRT modality on serum lipid and Lp(a) levels.
- To compare Lp(a) and lipid profiles across different RRT methods including transplantation, CAPD, and HD.
Main Methods:
- Study included three groups: patients transplanted post-dialysis, those who lost transplants, and those switching from CAPD to HD.
- Lp(a) and lipid levels were measured at least 3 months after RRT modification.
- Statistical analysis was performed to compare pre- and post-change measurements.
Main Results:
- Post-transplantation, CAPD patients showed a significant decrease in Lp(a) levels.
- Patients switching from CAPD to HD experienced a decrease in Lp(a), cholesterol, and LDL levels.
- Patients starting CAPD showed a marked increase in Lp(a) levels, while those starting HD had minimal change.
Conclusions:
- The mode of RRT significantly affects serum Lp(a) levels, with CAPD associated with the highest levels.
- Serum Lp(a) levels decrease after kidney transplantation or conversion from CAPD to HD.
- Atherogenic risk likely differs across RRT modalities, potentially being greatest in patients on CAPD.
Abstract:
Lipoprotein (a) [Lp(a)] is an independent atherogenic risk factor. Lp(a) levels are elevated in patients on renal replacement therapy (RRT). This study looked at the effect of change of RRT on serum lipid and Lp(a) levels. Three groups were identified: (1) patients on dialysis who were transplanted; (2) those who had lost their transplants through immunorejection; (3) those who changed from continuous ambulatory peritoneal dialysis (CAPD) to hemodialysis (HD). All Lp(a) measurements were taken at least 3 months after the change of therapy. Our results were as follows: Group A (n = 21): 8 CAPD and 13 HD patients were transplanted. Median Lp(a) levels fell posttransplantation in the CAPD group (15.6 mg/dL vs 11.4 mg/dL, p = 0.04). The HD group showed a rise in cholesterol, low-density (LDL) and high-density lipoprotein (HDL) levels, with no change in Lp(a) levels. Group B (n = 11): 7 patients started CAPD and 4 HD. Overall, there was a marked increase in Lp(a) levels: median 38.2 mg/dL vs 55.9 mg/dL (p = 0.04), reflecting an increase in those starting CAPD (27.8 mg/dL vs 60.0 mg/dL, p = 0.01), with little change in the HD group (40.45 mg/dL vs 40.05 mg/dL). However, there was a decrease in cholesterol (7.4 mmol/L vs 5.1 mmol/L, p = 0.002) and LDL (5.5 mmol/L vs 3.3 mmol/L, p = 0.004). Group C (n = 16): 16 patients changed from CAPD to HD. Lp(a) levels were higher while on CAPD, as compared to when on HD (58.9 mg/dL vs 49 mg/dL, p = 0.03). Cholesterol (6.62 mmol/L vs 5.26 mmol/L, p = 0.006) and LDL (4.48 mmol/L vs 3.40 mmol/L, p = 0.004) were also higher when on CAPD. In conclusion, serum Lp(a) levels are clearly affected by the mode of the RRT, being highest in CAPD, and decline after transplantation or conversion to HD. Atherogenic risk is thus likely to differ between the modes of RRT and may be greatest for those on CAPD.