Cardiovascular Risk Factors in Patients with Chronic Renal Failure Maintained on Hemodialysis or Continuous Ambulatory Peritoneal Dialysis

The association between serum ApoE genetic polymorphism and serum lipid level in hemodialysis patients

Growing evidence indicates that apolipoprotein E (ApoE) is one of the most important candidate genes for influencing the development of hemodialysis (HD). This study aims to detect the potential association between serum ApoE genetic polymorphism and serum lipid level in HD. A total of 485 subjects were enrolled in this case-control study. The created restriction site polymerase chain reaction and DNA sequencing methods were used to investigate ApoE c.109G>A genetic polymorphism. Our data suggested that there were significant differences in the distribution of allelic and genotypic frequencies between HD patients and healthy controls. The levels of total cholesterol, triglyceride, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, ApoA-I, ApoB, ApoE, and lipoprotein (a) for genotype AA were different from genotype GG in HD patients and healthy controls. Our findings support that the ApoE c.109G>A genetic polymorphism might influence the development of HD and could be a risk factor for assessing HD.

The effects of serum apolipoprotein E genetic variants and concentration on serum lipid parameters in haemodialysis patients

Objectives

Many epidemiological studies demonstrate that the apolipoprotein E gene (ApoE) is an important candidate gene for playing key roles in the development of haemodialysis (HD). The purpose of this study is to evaluate the effects of ApoE genetic variants and concentration on serum lipid parameters in HD.

Methods

A total of 288 HD patients and 292 healthy controls were enrolled in this case–control study. The genotypes of ApoE genetic variants were investigated through the created restriction site-polymerase chain reaction and DNA-sequencing methods.

Key findings

Our data indicated that the levels of triglyceride, total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, apolipoprotein A-I (ApoA-I), ApoB, ApoE, lipoprotein (a) (Lp(a)) of mutant genotypes in ApoE c.61G > A and c.761T > A genetic variants were different from those subjects with wild genotype in HD patients and healthy controls.

Conclusions

These preliminary results from this study suggest that the ApoE genetic variants and concentration could affect the serum lipid parameters in HD and could be risk factors for evaluating HD.

LDL susceptibility to oxidation and HDL antioxidant capacity in patients with renal failure

OBJECTIVES

This study examines the susceptibility to oxidation and the ability to stimulate reactive oxygen species of LDL from hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD) patients. It was also designed to evaluate the antioxidant activity of HDL from uremic patients.

DESIGN AND METHODS

Lipoprotein properties were determined in 28 HD patients, 30 CAPD patients and 30 control subjects by spectrophotometric, chemiluminescence and electrophoresis methods.

RESULTS

CAPD LDL were more resistant to oxidation than control LDL. HD and control LDL, in contrast to CAPD LDL, stimulated reactive oxygen species generation in granulocytes. The HDL ability to protect LDL against oxidation was impaired in renal patients.

CONCLUSIONS

The risk of atherosclerosis development in patients with renal failure does not appear to be related to less resistance of LDL to oxidation, but rather to the decreased HDL antioxidant capacity.

Effect of dialysis modality on plasma fibrinogen concentration: A meta-analysis

BACKGROUND

Concentrations of plasma fibrinogen, a vascular risk factor, tend to be greater in patients on peritoneal dialysis (PD) than hemodialysis (HD) therapy, like concentrations of serum cholesterol, lipoprotein(a), and transthyretin, despite the substantial loss of protein during PD. Worse vascular outcome has been noted in PD patients compared with HD patients in several studies.

METHODS

In this study, the mean difference in plasma fibrinogen levels (PD-HD) was quantified by means of meta-analysis of mean differences found in 12 cohorts with both PD and HD patients (set 1; N = 630) by using a fixed-effects model and meta-analysis of mean fibrinogen values reported in 30 cohorts of patients on a single dialysis modality (set 2; 8 PD cohorts, 22 HD cohorts; N = 2,096) by using a mixed model.

RESULTS

On meta-analysis, the weighted mean difference (PD-HD) was 105 mg/dL (95% confidence interval [CI], 86 to 124 [3.1 micromol/L; 95% CI, 2.5 to 3.6]) in set 1 and 103 mg/dL (95% CI, 53 to 153 [3.0 micromol/L; 95% CI, 1.6 to 4.5) in set 2.

CONCLUSION

Like other vascular risk factors, such as cholesterol and lipoprotein(a), plasma fibrinogen level is markedly greater in PD than HD patients, with an approximate difference of 100 mg/dL [2.9 mumol/L]. Different plasma reference ranges for fibrinogen need to be defined for PD and HD patients. The mechanism for the difference and the possible role of hyperfibrinogenemia in worsening vascular disease in PD patients deserve study.