title: Apoprotein B/Apoprotein A-1 Ratio and Mortality among Prevalent Dialysis Patients.
abstract: In dialysis patients, the associations between apoprotein profile and all-cause or cardiovascular disease (CVD)-related mortality are not well known. We, therefore, investigated whether apoprotein levels are associated with these events.
  
  
  
  We undertook a prospective observational cohort study of prevalent hemodialysis patients aged ≥18 years (n=1081), who were followed for 4 years (2011-2014). Outcomes were all-cause and CVD-related mortality. Predictors used were baseline apoprotein levels, particularly the apoprotein B (apo B)/ apoprotein A-1 (apo A-1) ratio. A Cox regression analysis was used to calculate the hazard ratios (HRs) for mortality. Apo A-1, apo B, and apo B/ apo A-1 ratio were analyzed with adjustments in three models: model 1, basic adjustment for age and sex; model 2, basic adjustments plus dialysis conditions (dialysis vintage, mean predialysis systolic blood pressure, dry weight, and mean intradialytic weight gain); and model 3, model 2 plus metabolic and inflammatory conditions (basal kidney disease, serum albumin, C-reactive protein level, and statin use).
  
  
  
  Of the 1081 patients included in the study, 203 deaths were recorded, 92 of which were related to CVD. The apo B/ apo A-1 ratio was significantly associated with all-cause and CVD-related mortality when analyzed by 1-SD increments or quartile IV versus I in all models. In model 3, HRs and 95% confidence intervals (95% CIs) for 1-SD increments of apo B/ apo A-1 ratio for all-cause mortality or CVD-related mortality were: HR, 1.16 (95% CI, 1.00 to 1.35), or HR, 1.38 (95% CI, 1.11 to 1.71), respectively, and for quartile IV versus I: HR, 1.65 (95% CI, 1.05 to 2.57), or HR, 2.56 (95% CI, 1.21 to 5.40), respectively. Apo A-1 was significantly associated with both mortalities in models 1 and 2. However, apo B was only significantly associated with CVD-related mortality in model 3.
  
  
  
  Apoprotein measurement, especially the apo B/ apo A-1 ratio, was significantly associated with all-cause and CVD-related mortality in prevalent dialysis patients.
authors.affiliation: Dialysis Division, University of Miyazaki Hospital, Miyazaki, Japan; and.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Sato
authors.affiliation: Departments of Hemovascular Medicine and Artificial Organs, and.
authors.forename: Shouichi
authors.initials: S
authors.lastname: Fujimoto
authors.affiliation: Departments of Hemovascular Medicine and Artificial Organs, and.
authors.forename: Tatsunori
authors.initials: T
authors.lastname: Toida
authors.affiliation: Dialysis Division, University of Miyazaki Hospital, Miyazaki, Japan; and.
authors.forename: Hideto
authors.initials: H
authors.lastname: Nakagawa
authors.affiliation: Division of Circulatory and Body Fluid Regulation, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Yamashita
authors.affiliation: Division of Circulatory and Body Fluid Regulation, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Iwakiri
authors.affiliation: Dialysis Division, University of Miyazaki Hospital, Miyazaki, Japan; and.
authors.forename: Akihiro
authors.initials: A
authors.lastname: Fukuda
authors.affiliation: Division of Circulatory and Body Fluid Regulation, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan.
authors.forename: Shuji
authors.initials: S
authors.lastname: Iwatsubo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016632:Apolipoprotein A-I / Q000097:blood*; D001055:Apolipoproteins B / Q000097:blood*; D002097:C-Reactive Protein / Q000378:metabolism; D002318:Cardiovascular Diseases / Q000401:mortality*; D002423:Cause of Death; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007239:Infections / Q000401:mortality; D008075:Lipoproteins, HDL / Q000097:blood; D008077:Lipoproteins, LDL / Q000097:blood; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000401:mortality; D016016:Proportional Hazards Models; D011446:Prospective Studies; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000097:blood* / Q000628:therapy; D012307:Risk Factors
chemical_list: D016632:Apolipoprotein A-I; D001055:Apolipoproteins B; D008075:Lipoproteins, HDL; D008077:Lipoproteins, LDL; D002097:C-Reactive Protein
keywords: Apoprotein; C-Reactive Protein; Humans; Kidney Diseases; Prospective Studies; Regression Analysis; blood pressure; cardiovascular disease; hemodialysis; mortality