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Apolipoprotein B, fibrinogen, HDL cholesterol, and apolipoprotein(a) phenotypes predict coronary artery disease in hemodialysis patients.

M Koch, B Kutkuhn, E Trenkwalder, D Bach, B Grabensee, H Dieplinger and F Kronenberg
JASN December 1997, 8 (12) 1889-1898;
M Koch
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B Kutkuhn
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E Trenkwalder
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D Bach
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B Grabensee
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H Dieplinger
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F Kronenberg
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Abstract

Patients with end-stage renal disease have a markedly elevated risk for coronary artery disease (CAD). Lipids and most lipoproteins, however, seem to be not predictive for CAD in these patients. Although there is clear evidence that lipoprotein(a) [Lp(a)] is significantly elevated in these patients, no study with a sufficiently large group of hemodialysis patients has investigated the relationship between CAD and Lp(a), as well as the genetically determined apolipoprotein(a) [apo(a)] phenotype. This cross-sectional study determines the prevalence of CAD in relation to the cardiovascular risk profile in an unselected population of 607 hemodialysis patients, of which 33% were diabetic patients. Twenty-six percent (n = 158) of all patients suffered from CAD as diagnosed by a definitive myocardial infarction (n = 102) and/or at least one stenosis >50% of a coronary artery (n = 143). In univariate analysis, several classic risk factors, including the concentration of lipids, lipoproteins, apolipoproteins, and fibrinogen, correlated with CAD. Lp(a) in patients with CAD showed only a tendency to higher levels, without reaching significance, compared with patients without CAD (26.6 +/- 30.8 mg/dl versus 22.1 +/- 30.4 mg/dl, P = 0.10). The frequency of low molecular weight apo(a) isoforms, however, was significantly greater in the group with CAD (34.8% versus 23.6%, P < 0.01). Stepwise logistic regression analysis found seven variables associated with CAD: apolipoprotein B, the low molecular weight apo(a) phenotype, male sex, age, fibrinogen, diabetes mellitus, and HDL cholesterol. The association of these variables with CAD differed depending on age. These results indicate that, besides classic risk factors such as age, sex, and diabetes mellitus, additional factors of the lipoprotein and fibrinolytic system contribute to the high prevalence of CAD in hemodialysis patients.

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Journal of the American Society of Nephrology
Vol. 8, Issue 12
1 Dec 1997
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Apolipoprotein B, fibrinogen, HDL cholesterol, and apolipoprotein(a) phenotypes predict coronary artery disease in hemodialysis patients.
M Koch, B Kutkuhn, E Trenkwalder, D Bach, B Grabensee, H Dieplinger, F Kronenberg
JASN Dec 1997, 8 (12) 1889-1898;

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Apolipoprotein B, fibrinogen, HDL cholesterol, and apolipoprotein(a) phenotypes predict coronary artery disease in hemodialysis patients.
M Koch, B Kutkuhn, E Trenkwalder, D Bach, B Grabensee, H Dieplinger, F Kronenberg
JASN Dec 1997, 8 (12) 1889-1898;
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Cited By...

  • HDL in CKD--The Devil Is in the Detail
  • The role of lipoprotein (a) in chronic kidney disease
  • Apoprotein B/Apoprotein A-1 Ratio and Mortality among Prevalent Dialysis Patients
  • HDL Cholesterol, Apolipoproteins, and Cardiovascular Risk in Hemodialysis Patients
  • Coronary Disease Risk Curve of Serum Creatinine Is Linear in Turkish Men, U-Shaped in Women
  • Lipoprotein Metabolism and Lipid Management in Chronic Kidney Disease
  • Lipoprotein(a) as a Predictor of Cardiovascular Disease in a Prospectively Followed Cohort of Patients With Type 1 Diabetes
  • Prospective Study of Lipoprotein(a) as a Risk Factor for Deteriorating Renal Function in Type 2 Diabetic Patients With Overt Proteinuria
  • Is a Single Time Point C-Reactive Protein Predictive of Outcome in Peritoneal Dialysis Patients?
  • Apolipoprotein A-IV Serum Concentrations Are Elevated in Patients with Mild and Moderate Renal Failure
  • Reduced kidney function and anemia as risk factors for mortality in patients with left ventricular dysfunction
  • Circulating Levels of Plasminogen Activator Inhibitor Type-1, Tissue Plasminogen Activator, and Thrombomodulin in Hemodialysis Patients: Biochemical Correlations and Role as Independent Predictors of Coronary Artery Stenosis
  • Impact of Apolipoprotein(a) Phenotypes on Long-Term Renal Transplant Survival
  • Increased Albumin and Fibrinogen Synthesis in Hemodialysis Patients with Normal Nutritional Status
  • Lipoprotein(a) Serum Concentrations and Apolipoprotein(a) Phenotypes in Mild and Moderate Renal Failure
  • The Low Molecular Weight Apo(a) Phenotype Is an Independent Predictor for Coronary Artery Disease in Hemodialysis Patients: A ProspectiveFollow-Up
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