title: Why are lipids not predictive of cardiovascular death in the dialysis patient?
abstract: The rate of cardiovascular death, and specifically of cardiac death, in dialysis patient is excessive and comparable to that in the high-risk group of survivors of myocardial infarction. Yet, in patients on dialysis total cholesterol, LDL cholesterol, apolipoprotein B and other indicators of coronary risk--with the exception of lipoprotein(a)--are consistently higher in survivors than in those dying from cardiovascular causes, but at least in diabetic patients on dialysis, an extremely high-risk population, lipids are predictive of cardiac death. Malnutrition as a confounding factor might explain the inverse relation between lipid indicators and cardiac death in nondiabetic patients. Indirect arguments can be marshalled that malnutrition increases cardiac death as a consequence of low L-arginine levels and the ensuing diminished synthesis of NO.
authors.affiliation: Department of Internal Medicine, Ruperto Carola University Heidelberg, Germany.
authors.forename: E
authors.initials: E
authors.lastname: Ritz
mesh_terms: D001055:Apolipoproteins B / Q000097:blood*; D001120:Arginine / Q000378:metabolism; D001161:Arteriosclerosis / Q000453:epidemiology / Q000401:mortality; D001794:Blood Pressure; D002318:Cardiovascular Diseases / Q000401:mortality*; D002784:Cholesterol / Q000097:blood*; D008078:Cholesterol, LDL / Q000097:blood*; D003922:Diabetes Mellitus, Type 1 / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D003924:Diabetes Mellitus, Type 2 / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D003928:Diabetic Nephropathies / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D006331:Heart Diseases / Q000453:epidemiology* / Q000401:mortality; D006801:Humans; D017270:Lipoprotein(a) / Q000097:blood; D009748:Nutrition Disorders / Q000209:etiology; D011237:Predictive Value of Tests; D006435:Renal Dialysis; D018570:Risk Assessment; D015996:Survival Rate
chemical_list: D001055:Apolipoproteins B; D008078:Cholesterol, LDL; D017270:Lipoprotein(a); D001120:Arginine; D002784:Cholesterol