title: Kidney Function as a Determinant of HDL and Triglyceride Concentrations in the Australian Population.
abstract: BACKGROUND
  Chronic kidney disease (CKD) is a potent risk factor for cardiovascular disease (CVD). CVD risk increases in a stepwise manner with increasing kidney impairment and is significantly reduced by kidney transplantation, suggesting a causal relationship. Dyslipidemia, a well recognised CVD risk factor, is highly prevalent in CKD. While dyslipidemia is a risk factor for CKD, kidney impairment can also induce a dyslipidemic state that may contribute to the excess burden of CVD in CKD. We utilised a multipronged approach to determine whether a causal relationship exists.
  
  
  METHODS
  Retrospective case-control analysis of 816 patients admitted to the Royal Hobart Hospital in 2008-2009 with different degrees of kidney impairment and retrospective before-after cohort analysis of 60 patients who received a transplanted kidney between 1999 and 2009.
  
  
  RESULTS
  Decreased estimated GFR (eGFR) was independently associated with decreased high density lipoprotein (HDL, p < 0.0001) and increased triglyceride concentrations (p < 0.01) in multivariate analysis. There was no significant relationship between eGFR and low density lipoprotein (LDL) or total cholesterol in multivariate analysis. Kidney transplantation increased HDL (p < 0.0001) and decreased triglyceride (p = 0.007) concentration, whereas there was no significant change in LDL and total cholesterol. These effects were dependent on maintenance of graft function, statin therapy (those who were on) if graft failure occurred then HDL again decreased and triglycerides increased.
  
  
  CONCLUSIONS
  Kidney transplantation ameliorated alterations in plasma lipoprotein profile associated with kidney impairment, an effect that was dependent on the maintenance of graft function. These data suggest that kidney function is a determinant of HDL and triglyceride concentrations in patients with CKD.
authors.affiliation: Royal Hobart Hospital, University of Tasmania, GPO Box-1061, Hobart 7000, Australia. michael.thompson@ths.tas.gov.au.
authors.forename: Michael
authors.initials: M
authors.lastname: Thompson
authors.affiliation: Royal Hobart Hospital, University of Tasmania, GPO Box-1061, Hobart 7000, Australia. Udayan.ray@dhhs.tas.gov.au.
authors.forename: Udayan
authors.initials: U
authors.lastname: Ray
authors.affiliation: Royal Hobart Hospital, University of Tasmania, GPO Box-1061, Hobart 7000, Australia. richard.yu@ths.tas.gov.au.
authors.forename: Richard
authors.initials: R
authors.lastname: Yu
authors.affiliation: Royal Hobart Hospital, University of Tasmania, GPO Box-1061, Hobart 7000, Australia. andrew.hudspeth@ths.tas.gov.au.
authors.forename: Andrew
authors.initials: A
authors.lastname: Hudspeth
authors.affiliation: Royal Hobart Hospital, University of Tasmania, GPO Box-1061, Hobart 7000, Australia. michael.smillie@ths.tas.gov.au.
authors.forename: Michael
authors.initials: M
authors.lastname: Smillie
authors.affiliation: Royal Hobart Hospital, University of Tasmania, GPO Box-1061, Hobart 7000, Australia. neville.jordan@ths.tas.gov.au.
authors.forename: Neville
authors.initials: N
authors.lastname: Jordan
authors.affiliation: Royal Hobart Hospital, University of Tasmania, GPO Box-1061, Hobart 7000, Australia. janet.bartle@ths.tas.gov.au.
authors.forename: Janet
authors.initials: J
authors.lastname: Bartle
keywords: CKD; CVD; HDL; kidney transplantation; lipids; triglycerides