title: High density lipoprotein cholesterol levels are an independent predictor of the progression of chronic kidney disease.
abstract: OBJECTIVE
  Patients with chronic kidney disease (CKD) often present with reduced plasma HDL cholesterol (HDL-C) levels. Whether this reduction in an epiphenomenon or is involved in disease progression is unclear. The aim of this study was to investigate the relation between HDL-C levels/function and CKD progression in patients with different degrees of disease.
  
  
  METHODS
  A total of 176 patients with CKD [glomerular filtration rate (GFR) 50.3 ± 29.1 mL min⁻¹] were recruited and followed for up to 84 months. Lipid profile, metabolic status and kidney function were evaluated at predetermined times. Age-matched control subjects were selected from the PLIC study (n = 453). Scavenger receptor class B member 1 (SR-BI) and ATP-binding cassette transporter A1 (ABCA-1)-dependent efflux of cholesterol were measured in CKD patients and in age-matched control subjects.
  
  
  RESULTS
  Low HDL-C levels, diabetes and hypertension were associated with reduced GFR. At follow-up, low HDL-C levels were associated with earlier entry in dialysis or doubling of the plasma creatinine level (P = 0.017); HDL-C levels were the only lipid parameter that affected the progression of CKD (hazard ratio 0.951, 95% confidence interval 0.917-0.986, P = 0.007), independently of the presence of diabetes. Only SR-BI-mediated serum cholesterol efflux was significantly reduced in the group of CKD patients with low HDL-C levels compared to the control group.
  
  
  CONCLUSIONS
  CKD patients with low levels of plasma HDL-C have a poor prognosis. HDL functionality is also impaired in renal dysfunction. These data support the relevance of HDL in influencing CKD progression.
authors.affiliation: Center for the Study of Atherosclerosis, Bassini Hospital, Cinisello Balsamo, Milan, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Baragetti
authors.forename: G D
authors.initials: GD
authors.lastname: Norata
authors.forename: C
authors.initials: C
authors.lastname: Sarcina
authors.forename: F
authors.initials: F
authors.lastname: Rastelli
authors.forename: L
authors.initials: L
authors.lastname: Grigore
authors.forename: K
authors.initials: K
authors.lastname: Garlaschelli
authors.forename: P
authors.initials: P
authors.lastname: Uboldi
authors.forename: I
authors.initials: I
authors.lastname: Baragetti
authors.forename: C
authors.initials: C
authors.lastname: Pozzi
authors.forename: A L
authors.initials: AL
authors.lastname: Catapano
mesh_terms: D018528:ATP-Binding Cassette Transporters / Q000097:blood; D000368:Aged; D016022:Case-Control Studies; D008076:Cholesterol, HDL / Q000097:blood*; D003404:Creatinine / Q000097:blood; D018450:Disease Progression; D005260:Female; D006801:Humans; D007677:Kidney Function Tests; D008297:Male; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D012044:Regression Analysis; D051436:Renal Insufficiency, Chronic / Q000097:blood* / Q000503:physiopathology*; D012307:Risk Factors; D051122:Scavenger Receptors, Class B / Q000097:blood
chemical_list: D018528:ATP-Binding Cassette Transporters; D008076:Cholesterol, HDL; D051122:Scavenger Receptors, Class B; D003404:Creatinine
keywords: ABCA-1; HDL; SR-BI; cholesterol efflux; chronic kidney disease; dialysis