title: Quantification of HDL proteins, cardiac events, and mortality in patients with type 2 diabetes on hemodialysis.
abstract: OBJECTIVE
  Impairment of HDL function has been associated with cardiovascular events in patients with kidney failure. The protein composition of HDLs is altered in these patients, presumably compromising the cardioprotective effects of HDLs. This post hoc study assessed the relation of distinct HDL-bound proteins with cardiovascular outcomes in a dialysis population.
  
  
  METHODS
  The concentrations of HDL-associated serum amyloid A (SAA) and surfactant protein B (SP-B) were measured in 1152 patients with type 2 diabetes mellitus on hemodialysis participating in The German Diabetes Dialysis Study who were randomly assigned to double-blind treatment of 20 mg atorvastatin daily or matching placebo. The association of SAA(HDL) and SP-B(HDL) with cardiovascular outcomes was assessed in multivariate regression models adjusted for known clinical risk factors.
  
  
  RESULTS
  High concentrations of SAA(HDL) were significantly and positively associated with the risk of cardiac events (hazard ratio per 1 SD higher, 1.09; 95% confidence interval, 1.01 to 1.19). High concentrations of SP-B(HDL) were significantly associated with all-cause mortality (hazard ratio per 1 SD higher, 1.10; 95% confidence interval, 1.02 to 1.19). Adjustment for HDL cholesterol did not affect these associations.
  
  
  CONCLUSIONS
  In patients with diabetes on hemodialysis, SAA(HDL) and SP-B(HDL) were related to cardiac events and all-cause mortality, respectively, and they were independent of HDL cholesterol. These findings indicate that a remodeling of the HDL proteome was associated with a higher risk for cardiovascular events and mortality in patients with ESRD.
authors.affiliation: Department of Internal Medicine III, Division of Nephrology and Dialysis and.
authors.forename: Chantal
authors.initials: C
authors.lastname: Kopecky
authors.affiliation: BGStats Consulting, Vienna, Austria; Mannheim Institute of Public Health, Social and Preventive Medicine, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany; Institute of Public Health, Federal University of Bahia, Salvador, Brazil;
authors.forename: Bernd
authors.initials: B
authors.lastname: Genser
authors.affiliation: Department of Medicine, Division of Nephrology, University Hospital, Würzburg, Germany;
authors.forename: Christiane
authors.initials: C
authors.lastname: Drechsler
authors.affiliation: Department of Medicine, Division of Nephrology, University Hospital, Würzburg, Germany;
authors.forename: Vera
authors.initials: V
authors.lastname: Krane
authors.affiliation: Department of Internal Medicine III, Division of Nephrology and Dialysis and.
authors.forename: Christopher C
authors.initials: CC
authors.lastname: Kaltenecker
authors.affiliation: Institute of Medical Genetics, Medical University of Vienna, Vienna, Austria;
authors.forename: Markus
authors.initials: M
authors.lastname: Hengstschläger
authors.affiliation: Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria; Medical Clinic V (Nephrology, Hypertensiology, Endocrinology, Diabetology, Rheumatology), Mannheim Medical Faculty, Heidelberg University, Mannheim, Germany; and Synlab Academy, Synlab Laboratory Services GmbH, Mannheim, Germany.
authors.forename: Winfried
authors.initials: W
authors.lastname: März
authors.affiliation: Department of Medicine, Division of Nephrology, University Hospital, Würzburg, Germany;
authors.forename: Christoph
authors.initials: C
authors.lastname: Wanner
authors.affiliation: Department of Internal Medicine III, Division of Nephrology and Dialysis and.
authors.forename: Marcus D
authors.initials: MD
authors.lastname: Säemann
authors.affiliation: Institute of Medical Genetics, Medical University of Vienna, Vienna, Austria; thomas.weichhart@meduniwien.ac.at.
authors.forename: Thomas
authors.initials: T
authors.lastname: Weichhart
mesh_terms: D000368:Aged; D000069059:Atorvastatin; D015415:Biomarkers / Q000097:blood; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy; D003928:Diabetic Nephropathies / Q000097:blood / Q000175:diagnosis / Q000209:etiology / Q000401:mortality* / Q000628:therapy*; D004311:Double-Blind Method; D005260:Female; D005858:Germany; D006331:Heart Diseases / Q000097:blood / Q000175:diagnosis / Q000209:etiology / Q000401:mortality* / Q000628:therapy; D006538:Heptanoic Acids / Q000627:therapeutic use; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D007676:Kidney Failure, Chronic / Q000097:blood / Q000175:diagnosis / Q000209:etiology / Q000401:mortality* / Q000628:therapy*; D008075:Lipoproteins, HDL / Q000097:blood*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D037701:Pulmonary Surfactant-Associated Protein B / Q000097:blood; D011758:Pyrroles / Q000627:therapeutic use; D006435:Renal Dialysis / Q000009:adverse effects / Q000401:mortality*; D012307:Risk Factors; D000685:Serum Amyloid A Protein / Q000378:metabolism; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D006538:Heptanoic Acids; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D008075:Lipoproteins, HDL; D037701:Pulmonary Surfactant-Associated Protein B; D011758:Pyrroles; D000685:Serum Amyloid A Protein; D000069059:Atorvastatin
keywords: cardiovascular disease; dialysis; lipids