title: Association of apolipoprotein A1 and B with kidney function and chronic kidney disease in two multiethnic population samples.
abstract: BACKGROUND
  Circulating lipoproteins and their protein constituents, apolipoproteins, are risk factors for chronic kidney disease (CKD). The associations between apolipoprotein A1, apolipoprotein B and their ratio with glomerular filtration rate estimated from the new CKD Epidemiology Collaboration (CKD-EPI) equation (eGFR) are not well studied in the general population.
  
  
  METHODS
  Associations between apolipoprotein A1, B and their ratio with the outcomes of eGFR, CKD (eGFR<60 mL/min/1.73 m2) and albuminuria were examined in the Atherosclerosis Risk in Communities study (ARIC, n=10,292, 1996-98) and the Third National Health and Nutrition Examination Survey (NHANES III, n=7023, 1988-91). Cross-sectional multivariable-adjusted analyses were performed using linear and logistic regression. Prospective analyses related baseline apolipoprotein levels to subsequent CKD incidence over 10 years using the ARIC Carotid MRI follow-up cohort (n=1659).
  
  
  RESULTS
  Higher apolipoprotein A1 quartiles were associated with a lower prevalence of CKD [Q4 versus Q1: odds ratio (OR) 0.73, P-trend=0.02 in ARIC; Q4 versus Q1: OR 0.53, P-trend<0.01 in NHANES III] as well as with higher eGFR (P-trend<0.01 in ARIC and NHANES III). No consistent significant associations were found for apolipoprotein B in either study. The apolipoprotein B/A1 ratio was significantly associated with eGFR across quartiles in both studies (P-trend<0.01) and with CKD in ARIC (Q4 versus Q1: OR 1.23, P-trend=0.01). Prospectively, there were trends for the association of apolipoproteins with incident CKD [Q4 versus Q1: incidence rate ratio (IRR)=0.68 for apolipoprotein A1, P-trend=0.1; Q4 versus Q1: IRR=1.35 for apolipoprotein B, P-trend=0.2]. Associations were not systematically stronger when comparing traditional lipids (total cholesterol, low-density lipoprotein or high-density lipoprotein) to apolipoproteins.
  
  
  CONCLUSIONS
  Higher serum apolipoprotein A1 was associated with lower prevalence of CKD and higher eGFR estimated by the CKD-EPI equation in two large multiethnic population-based samples. While apolipoprotein B showed no consistent associations, a higher apolipoprotein B/A1 ratio was significantly associated with lower eGFR in both studies. The direction and magnitude of the longitudinal associations between apolipoproteins and CKD incidence were overall similar to those observed cross-sectionally. No consistent differences became apparent between traditional lipids and apolipoproteins.
authors.affiliation: Division of Nephrology, Department of Internal Medicine IV, University of Freiburg Medical Center, Freiburg, Germany.
authors.forename: Oemer-Necmi
authors.initials: ON
authors.lastname: Goek
authors.forename: Anna
authors.initials: A
authors.lastname: Köttgen
authors.forename: Ron C
authors.initials: RC
authors.lastname: Hoogeveen
authors.forename: Christie M
authors.initials: CM
authors.lastname: Ballantyne
authors.forename: Josef
authors.initials: J
authors.lastname: Coresh
authors.forename: Brad C
authors.initials: BC
authors.lastname: Astor
mesh_terms: D000328:Adult; D000419:Albuminuria / Q000209:etiology; D016632:Apolipoprotein A-I / Q000378:metabolism*; D001055:Apolipoproteins B / Q000378:metabolism*; D050197:Atherosclerosis / Q000150:complications / Q000503:physiopathology; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D007677:Kidney Function Tests; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009749:Nutrition Surveys; D011379:Prognosis; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis* / Q000453:epidemiology* / Q000378:metabolism; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D055815:Young Adult
chemical_list: D016632:Apolipoprotein A-I; D001055:Apolipoproteins B