The role of small, dense LDL cholesterol in progression of chronic kidney disease

Abstract

Dyslipidemia is a common metabolic disorder in chronic kidney disease (CKD) and is largely responsible for development of cardiovascular complications in these patients. It has been noticed that characteristics of lipid disorders vary according to the degree of renal failure. In this study, we investigated concentrations of cholesterol and apolipoprotein B in small, dense low-density lipoproteins (sdLDL-C and sdLDL-apoB) in pre-dialysis (PD) and hemodialysis (HD) stage of CKD. In addition, we explored independent contribution of sdLDL-C and sdLDL-apoB to progression of CKD. We recruited 38 PD and 41 HD patients in this study. Concentrations of sdLDL-C and sdLDL-apoB were determined by heparin-magnesium precipitation method. Other biochemical parameters were measured by routine laboratory methods. Concentrations of sdLDL-C and sdLDL-apoB were significantly higher in PD than in HD patients (P lt 0,001). SdLDL-C (OR=0,122; P lt 0,001) and sdLDL-apoB (OR=0,109; P lt 0,001) were identified as predictors of progression of CKD towards HD stage. Both of examined parameters were independently associated with the disease progression after adjustment for other lipid and non-lipid risk markers, with an exception for adjustment for urea concentration. Assessment of sdLDL-C and sdLDL-apoB in different stages of CKD could be beneficial in term of prediction of risk for cardiovascular disease development and prediction of progression of CKD itself.

Dislipidemija je uobičajen metabolički poremećaj u hroničnoj bubrežnoj bolesti (HBB) i u velikoj meri je odgovorna za nastanak kasnijih kardiovaskularnih komplikacija kod ovih pacijenata. Uočeno je da karakteristike dislipidemije variraju u zavisnosti od stadijuma HBB. U ovom radu ispitivali smo koncentracije holesterola i apolipoproteina B u malim, gustim česticama lipoproteina niske gustine (sdLDL-h i sdLDL-apoB) u predijaliznom (PD) i hemodijaliznom (HD) stadijumu HBB, kao i njihov nezavisni potencijal u predviđanju progresije HBB. U studiji je učestvovalo 38 PD i 41 HD pacijent. Koncentracije sdLDL-h i sdLDL-apoB određene su nakon selektivne precipitacije sa heparinom i Mg-solima, a koncentracije ostalih biohemijskih parametara rutinskim metodama. Koncentracije sdLDL-h i sdLDL-apoB bile su značajno više kod PD u odnosu na HD pacijente (P lt 0,001). SdLDL-h (OR=0,122; P lt 0,001) i sdLDL-apoB (OR=0,109; P lt 0,001) identifikovani su kao značajni prediktori progresije bolesti od PD do HD stadijuma, a nezavisan prediktivni potencijal zadržali su i u prisustvu drugih lipidnih i nelipidnih faktora rizika, osim uree. Određivanje sdLDL-h i sdLDL-apoB kod pacijenata u različitim stadijumima HBB može biti korisno u smislu predviđanja rizika za nastanak aterosklerotskih promena, kao i predviđanja progresije same HBB.