title: Impaired postprandial lipemic response in chronic kidney disease.
abstract: Dyslipidemia in chronic kidney disease (CKD) is usually characterized by hypertriglyceridemia. Here we studied postprandial lipemia in children and young adults to determine whether an increasing degree of CKD results in a proportional increase in triglyceride and chylomicron concentration. Secondary goals were to determine whether subnephrotic proteinuria, apolipoprotein (apo)C-III and insulin resistance modify the CKD effect. Eighteen fasting participants (mean age of 15 years, mean glomerular filtration rate (GFR) of 50 ml/min/1.73 m(2)) underwent a postprandial challenge with a high fat milkshake. Triglycerides, apoB-48, insulin, and other markers were measured before and 2, 4, 6, and 8 hours afterward. Response was assessed by the incremental area under the curve of triglycerides and of apoB-48. The primary hypothesis was tested by correlation to estimated GFR. Significantly, for every 10 ml/min/1.73 m(2) lower estimated GFR, the incremental area under the curve of triglycerides was 17% greater while that of apoB-48 was 16% greater. Univariate analyses also showed that the incremental area under the curve of triglycerides and apoB-48 were significantly associated with subnephrotic proteinuria, apoC-III, and insulin resistance. In multivariate analysis, CKD and insulin resistance were independently associated with increased area under the curve and were each linked to increased levels of apoC-III. Thus, postprandial triglyceride and chylomicron plasma excursions are increased in direct proportion to the degree of CKD. Independent effects are associated with subclinical insulin resistance and increased apoC-III is linked to both CKD and insulin resistance.
authors.affiliation: Department of Pediatrics, The Icahn School of Medicine at Mount Sinai, New York, NY, USA. Electronic address: Jeff.Saland@MSSM.edu.
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Saland
authors.affiliation: Department of Pediatrics, The Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Satlin
authors.affiliation: Department of Pediatrics, The Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: Jeanna
authors.initials: J
authors.lastname: Zalsos-Johnson
authors.affiliation: Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA; The Irving Institute for Clinical and Translational Research, Columbia University College of Physicians and Surgeons, New York, NY, USA.
authors.forename: Serge
authors.initials: S
authors.lastname: Cremers
authors.affiliation: Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA; The Irving Institute for Clinical and Translational Research, Columbia University College of Physicians and Surgeons, New York, NY, USA.
authors.forename: Henry N
authors.initials: HN
authors.lastname: Ginsberg
mesh_terms: D000293:Adolescent; D000328:Adult; D053283:Apolipoprotein B-48 / Q000097:blood*; D053305:Apolipoprotein C-III / Q000097:blood; D002648:Child; D002914:Chylomicrons / Q000097:blood* / Q000378:metabolism; D005215:Fasting; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D015228:Hypertriglyceridemia / Q000150:complications*; D007333:Insulin Resistance; D008297:Male; D019518:Postprandial Period; D011507:Proteinuria / Q000209:etiology / Q000652:urine*; D051436:Renal Insufficiency, Chronic / Q000150:complications*; D014280:Triglycerides / Q000097:blood* / Q000378:metabolism; D055815:Young Adult
chemical_list: D053283:Apolipoprotein B-48; D053305:Apolipoprotein C-III; D002914:Chylomicrons; D014280:Triglycerides
keywords: chronic kidney disease; insulin resistance; lipids; nutrition; pediatric nephrology