title: Comparison of Lp(a) concentrations and some potential effects in hemodialysis, CAPD, transplantation, and control groups, and review of the literature.
abstract: Apolipoprotein (a)-Lp(a)-is reported to be an independent risk factor for coronary artery disease and for hemodialysis (HD) access occlusion. Homology with plasminogen may predispose to thrombosis. High concentrations usually have been reported in patients on HD and on continuous ambulatory peritoneal dialysis (CAPD), but near-normal values in many kidney transplants (TP). We used Pharmacia immunoradiometric assay in 52 patients on HD, 58 on CAPD, 94 after TP, and 56 controls. The Lp(a) mean levels for CAPD, HD, TP, and control groups were 738, 647, 348, and 368 U/l and the medians were 542, 537, 96 and 143 U/l, respectively. The means and medians for CAPD and HD were significantly greater than those for TP and controls (p < 0.003 for means and < 0.005 for medians). We found no significant difference between: (1) Lp(a) means or medians comparing HD and CAPD or TP and controls; (2) Lp(a) means for the 33 patients with insulin-dependent diabetes mellitus and the 171 without; (3) number of occlusions of HD fistulae or grafts in patients with high Lp(a) values and without; (4) mean Lp(a) for CAPD patients on gemfibrozil and also for TP patients on 3-hydroxy-methylglutaryl coenzyme 1 reductase inhibitors, or diet alone, before and after treatment, and (5) mean Lp(a) values for HD and CAPD patients with and without myocardial infarction. Lp(a) did not correlate significantly with fractional shortening or left ventricular end systolic or diastolic diameter by echocardiogram or with ejection fraction. For TP patients, Lp(a) and serum creatinine correlated (p = 0.004), and mean Lp(a) for 71 TP on ciclosporin A exceeded that for the other 23 patients (p < 0.03). Lp(a) fell in 13 of 14 patients after TP (mean fall 77%). The dominant Apo(a) isoform in 10 of 13 patients on CAPD or HD with high Lp(a) values was the equivalent of S2 (Utermann). Lp(a) in HD or CAPD is often elevated and regulated by both genetic and renal failure factors, but falls after TP with return of renal function and mainly genetic regulation. Lp(a) was not a risk factor for coronary artery disease in HD or CAPD patients and did not fall significantly with two drugs or diet.
authors.affiliation: Faculty of Medicine, Memorial University, Health Sciences Centre, St. John's Nfld., Canada.
authors.forename: M H
authors.initials: MH
authors.lastname: Gault
authors.forename: L L
authors.initials: LL
authors.lastname: Longerich
authors.forename: L
authors.initials: L
authors.lastname: Purchase
authors.forename: J
authors.initials: J
authors.lastname: Harnett
authors.forename: C
authors.initials: C
authors.lastname: Breckenridge
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D053299:Apolipoprotein B-100; D001054:Apolipoproteins A / Q000097:blood* / Q000187:drug effects; D001055:Apolipoproteins B / Q000097:blood; D002318:Cardiovascular Diseases / Q000150:complications / Q000000981:diagnostic imaging; D002648:Child; D002784:Cholesterol / Q000097:blood; D016572:Cyclosporine / Q000008:administration & dosage; D003627:Data Interpretation, Statistical; D003922:Diabetes Mellitus, Type 1 / Q000150:complications; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D015248:Gemfibrozil / Q000627:therapeutic use; D006083:Graft Occlusion, Vascular / Q000097:blood; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D025782:Hydroxymethylglutaryl-CoA-Reductases, NADP-dependent; D007527:Isoenzymes / Q000097:blood; D007668:Kidney / Q000503:physiopathology; D007677:Kidney Function Tests; D016030:Kidney Transplantation; D008075:Lipoproteins, HDL / Q000097:blood; D008077:Lipoproteins, LDL / Q000097:blood; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000097:blood; D010531:Peritoneal Dialysis, Continuous Ambulatory; D011863:Radioimmunoassay; D012016:Reference Values; D006435:Renal Dialysis; D014280:Triglycerides / Q000097:blood; D014463:Ultrasonography
chemical_list: D053299:Apolipoprotein B-100; D001054:Apolipoproteins A; D001055:Apolipoproteins B; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D007527:Isoenzymes; D008075:Lipoproteins, HDL; D008077:Lipoproteins, LDL; D014280:Triglycerides; D016572:Cyclosporine; D002784:Cholesterol; D025782:Hydroxymethylglutaryl-CoA-Reductases, NADP-dependent; D015248:Gemfibrozil