Small apolipoprotein(a) size predicts mortality in end-stage renal disease: The CHOICE study.

Abstract

BACKGROUND:

The high mortality rate in end-stage renal disease has engendered interest in nontraditional atherosclerotic cardiovascular disease (ASCVD) risk factors that are more prevalent in end-stage renal disease, such as elevated lipoprotein(a) [Lp(a)] levels. Previous studies suggest that high Lp(a) levels and small apolipoprotein(a) [apo(a)] isoform size are associated with ASCVD, but none have investigated the relationship between Lp(a) level, apo(a) size, and mortality.

METHODS AND RESULTS:

An inception cohort of 864 incident dialysis patients was followed prospectively. Lp(a) was measured by an apo(a) size-independent ELISA and apo(a) size by Western blot after SDS-agarose gel electrophoresis. Comorbid conditions were determined by medical record review. Time to death was ascertained through dialysis clinic and Health Care Financing Administration follow-up. Survival analyses were performed with adjustment for baseline demographic, comorbid conditions, albumin, and lipids. Median follow-up was 33.7 months, with 346 deaths, 162 transplantations, and 10 losses to follow-up during 1999 person-years of follow-up. Cox regression analysis showed no association between Lp(a) level and mortality. However, an association between small apo(a) isoform size and mortality was found (hazard ratio, 1.36; P=0.004) after adjusting for age, race, sex, comorbidity score, cause of renal disease, and congestive heart failure. The association was somewhat lower in white patients (hazard ratio 1.34; P=0.019) than in black patients (1.69; P=0.04). No interaction by age, race, sex, diabetes, ASCVD, or Lp(a) level was present.

CONCLUSIONS:

Small apo(a) size, but not Lp(a) level, independently predicts total mortality risk in dialysis patients.

• Authors: J Craig Longenecker, Michael J Klag, Santica M Marcovina, Neil R Powe, Nancy E Fink, Federico Giaculli, Josef Coresh, Choices for Healthy Outcomes in Caring for ESRD
• Journal: Circulation (Circulation) Vol. 106 Issue 22 Pg. 2812-8 (Nov 26 2002) ISSN: 1524-4539 [Electronic] United States
• PMID: 12451008 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't, Research Support, U.S. Gov't, P.H.S.)

Chemical References

• Apolipoproteins
• Biomarkers
• Lipoprotein(a)
• Apoprotein(a)

Topics

• Aged
• Apolipoproteins (blood, chemistry)
• Apoprotein(a)
• Biomarkers (blood, chemistry)
• Black People
• Blotting, Western
• Cohort Studies
• Enzyme-Linked Immunosorbent Assay
• Female
• Humans
• Kidney Failure, Chronic (blood, mortality)
• Lipoprotein(a) (blood, chemistry)
• Male
• Middle Aged
• Particle Size
• Predictive Value of Tests
• Proportional Hazards Models
• Prospective Studies
• Risk Factors
• Survival Rate
• United States (epidemiology)
• White People