Abstract | BACKGROUND: METHODS: We investigated 207 patients with nondiabetic nephrotic syndrome in whom Lp(a) concentrations were strikingly elevated when compared to 274 controls (60.4 +/- 85.4 mg/dL vs. 20.0 +/- 32.8 mg/dL, P < 0.0001). RESULTS: According to National Kidney Foundation Dialysis Outcomes Quality Initiative (K/DOQI) Clinical Practice Guidelines for Managing Dyslipidemias, almost 95% of these patients are candidates for a therapeutic intervention to lower LDL cholesterol. LDL cholesterol levels corrected for Lp(a)-derived cholesterol, however, were 27 mg/dL lower than uncorrected concentrations (compared to only 9 mg/dL in controls). If Lp(a)-corrected levels instead of total LDL cholesterol levels were used, 25.7% of patients with low-molecular-weight (LMW) apolipoprotein(a) [ apo(a)] isoforms were classified no longer to be in need of LDL cholesterol-lowering therapeutic intervention compared to only 2.3% of patients with high-molecular-weight (HMW) apo(a) phenotypes (P < 0.00001). This ("pseudo") pharmacogenetic effect results in incorrect determination of LDL cholesterol. CONCLUSION: Our observation has an impact on the indication for, and assessment of efficacy of intervention. This potential artifact should be investigated in ongoing large trials in renal patients as well as in nonrenal African American subjects who have on average markedly higher Lp(a) levels. In nonrenal Caucasian subjects with much lower Lp(a) concentrations, this issue will be less relevant.
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Authors | Florian Kronenberg, Arno Lingenhel, Karl Lhotta, Barbara Rantner, Martina F Kronenberg, Paul König, Joachim Thiery, Michael Koch, Arnold von Eckardstein, Hans Dieplinger |
Journal | Kidney international
(Kidney Int)
Vol. 66
Issue 1
Pg. 348-54
(Jul 2004)
ISSN: 0085-2538 [Print] United States |
PMID | 15200443
(Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
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Chemical References |
- Cholesterol, LDL
- Hypolipidemic Agents
- Lipoprotein(a)
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Topics |
- Adult
- Case-Control Studies
- Cholesterol, LDL
(blood)
- Female
- Humans
- Hypolipidemic Agents
(therapeutic use)
- Lipoprotein(a)
(blood)
- Male
- Middle Aged
- Nephrotic Syndrome
(blood, drug therapy, therapy)
- Peritoneal Dialysis, Continuous Ambulatory
- Renal Dialysis
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