The prevalence of nontraditional risk factors for coronary heart disease in patients with chronic kidney disease.
BACKGROUND
Risk for coronary heart disease is high among patients with chronic kidney disease.


OBJECTIVE
To compare the prevalence of low apolipoprotein A1 levels and elevated apolipoprotein B, plasma fibrinogen, lipoprotein(a), homocysteine, and C-reactive protein levels by estimated glomerular filtration rate (GFR).


METHODS
Cross-sectional study.


METHODS
Third National Health and Nutrition Examination survey.


METHODS
12 547, 3180, and 744 persons with estimated GFRs of at least 90, 60 to 89, or less than 60 mL/min per 1.73 m2, respectively, who were at least 18 years of age.


METHODS
Chronic kidney disease was defined as an estimated GFR of less than 60 mL/min per 1.73 m2 based on the abbreviated Modification of Diet in Renal Disease formula.


RESULTS
After standardization for age, race or ethnicity, and sex, lower estimated GFR (> or =90, 60 to 89, or <60 mL/min per 1.73 m2) was associated with lower average levels of apolipoprotein A1 (1.44, 1.43, and 1.35 g/L) and higher levels of apolipoprotein B (1.03, 1.06, and 1.08 g/L), plasma fibrinogen (8.43, 8.44, and 9.53 micromol/L), homocysteine (8.5, 10.0, and 13.2 micromol/L), and C-reactive protein (3.0, 2.9, and 3.9 mg/L) (P < 0.05 for all values). The multivariate-adjusted odds ratios of an apolipoprotein A1 level of less than 1.2 g/L, a serum lipoprotein(a) level of at least 1.61 micromol/L (> or =45.3 mg/dL), a plasma fibrinogen level of at least 10.35 micromol/L, a serum homocysteine level of at least 15 micromol/L, and a C-reactive protein level of at least 10.0 mg/L for participants with chronic kidney disease compared with those with a GFR of at least 90 mL/min per 1.73 m2 or greater were 1.92 (95% CI, 1.02 to 3.63), 1.82 (CI, 1.06 to 3.13), 1.74 (CI, 1.35 to 2.24), 8.23 (CI, 5.00 to 13.6), and 1.93 (CI, 1.33 to 2.81), respectively.


CONCLUSIONS
Levels of apolipoprotein A1 are decreased and levels of homocysteine, lipoprotein(a), fibrinogen, and C-reactive protein are increased among patients with chronic kidney disease.
Muntner
Paul
P
Tulane University, New Orleans, Louisiana, USA.
Hamm
L Lee
LL
Kusek
John W
JW
Chen
Jing
J
Whelton
Paul K
PK
He
Jiang
J
D000328:Adult; D000368:Aged; D016632:Apolipoprotein A-I / Q000097:blood; D001055:Apolipoproteins B / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism; D002908:Chronic Disease; D003327:Coronary Disease / Q000209:etiology*; D003430:Cross-Sectional Studies; D005260:Female; D005340:Fibrinogen / Q000378:metabolism; D005919:Glomerular Filtration Rate; D006710:Homocysteine / Q000097:blood; D006801:Humans; D007674:Kidney Diseases / Q000097:blood* / Q000150:complications*; D017270:Lipoprotein(a) / Q000097:blood; D008297:Male; D008875:Middle Aged; D012307:Risk Factors
D016632:Apolipoprotein A-I; D001055:Apolipoproteins B; D017270:Lipoprotein(a); D006710:Homocysteine; D005340:Fibrinogen; D002097:C-Reactive Protein