Why are lipids not predictive of cardiovascular death in the dialysis patient?
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.
Ritz
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Department of Internal Medicine, Ruperto Carola University Heidelberg, Germany.
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
D001055:Apolipoproteins B; D008078:Cholesterol, LDL; D017270:Lipoprotein(a); D001120:Arginine; D002784:Cholesterol