HDL Cholesterol Efflux Does Not Predict Cardiovascular Risk in Hemodialysis Patients.
The cardioprotective effect of HDL is thought to be largely determined by its cholesterol efflux capacity, which was shown to inversely correlate with atherosclerotic cardiovascular disease in populations with normal kidney function. Patients with ESRD suffer an exceptionally high cardiovascular risk not fully explained by traditional risk factors. Here, in apost hocanalysis in 1147 patients with type 2 diabetes mellitus on hemodialysis who participated in the German Diabetes Dialysis Study (4D Study), we investigated whether the HDL cholesterol efflux capacity is predictive for cardiovascular risk. Efflux capacity was quantified by incubating human macrophage foam cells with apoB-depleted serum. During a median follow-up of 4.1 years, 423 patients reached the combined primary end point (composite of cardiac death, nonfatal myocardial infarction, and stroke), 410 patients experienced cardiac events, and 561 patients died. Notably, in Cox regression analyses, we found no association of efflux capacity with the combined primary end point (hazard ratio [HR], 0.96; 95% confidence interval [95% CI], 0.88 to 1.06;P=0.42), cardiac events (HR, 0.92; 95% CI, 0.83 to 1.02;P=0.11), or all-cause mortality (HR, 0.96; 95% CI, 0.88 to 1.05;P=0.39). In conclusion, HDL cholesterol efflux capacity is not a prognostic cardiovascular risk marker in this cohort of patients with diabetes on hemodialysis.
Department of Internal Medicine III, Division of Nephrology and Dialysis and.
Chantal
C
Kopecky
Department of Pediatrics, Center for Liver, Digestive, and Metabolic Diseases and.
Sanam
S
Ebtehaj
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; and.
Bernd
B
Genser
Division of Nephrology, Department of Medicine 1 and.|Comprehensive Heart Failure Centre, University of Würzburg, Wurzburg, Germany.
Christiane
C
Drechsler
Division of Nephrology, Department of Medicine 1 and.|Comprehensive Heart Failure Centre, University of Würzburg, Wurzburg, Germany.
Vera
V
Krane
Department of Internal Medicine III, Division of Nephrology and Dialysis and.
Marlies
M
Antlanger
Department of Internal Medicine III, Division of Nephrology and Dialysis and.
Johannes J
JJ
Kovarik
Department of Internal Medicine III, Division of Nephrology and Dialysis and.
Christopher C
CC
Kaltenecker
Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Mojtaba
M
Parvizi
Division of Nephrology, Department of Medicine 1 and.|Comprehensive Heart Failure Centre, University of Würzburg, Wurzburg, Germany.
Christoph
C
Wanner
Institute of Medical Genetics, Medical University of Vienna, Vienna, Austria.
Thomas
T
Weichhart
Department of Internal Medicine III, Division of Nephrology and Dialysis and.
Marcus D
MD
Säemann
Department of Pediatrics, Center for Liver, Digestive, and Metabolic Diseases and u_tietge@yahoo.com.
Uwe J F
UJ
Tietge
D000368:Aged; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D008076:Cholesterol, HDL / Q000378:metabolism*; D005260:Female; D006801:Humans; D008297:Male; D011379:Prognosis; D006435:Renal Dialysis; D018570:Risk Assessment
D008076:Cholesterol, HDL
HDL; cardiovascular; cholesterol efflux; end-stage renal disease; risk factors