Independent Effects of Kidney Function and Cholesterol Efflux on Cardiovascular Mortality
Abstract BackgroundImpaired renal function is associated with cardiovascular and all-cause mortality. In the general population, HDL-cholesterol is associated with cardiovascular events, which is not true in patients with chronic kidney disease (CKD). This has been attributed to abnormal HDL function in CKD.MethodsIn this study, we analyzed the association between kidney function, cholesterol efflux capacity as one of the major HDL functions and cardiovascular mortality in 2469 patients of the Ludwigshafen Risk and Cardiovascular Health Study who all underwent coronary angiography.ResultsWe found a strong association between cholesterol efflux capacity and kidney function. Additionally, a genetic score of 53 SNPs associated with GRF and the uromodulin SNP rs12917707 was correlated inversely with cholesterol efflux. However, adjustment for eGFR and uromodulin as markers of kidney function did not affect the relationship between cholesterol efflux and cardiovascular mortality.ConclusionsWe suggest that impaired renal function lowers cholesterol efflux, but that this is not mediating the effects of impaired kidney function on cardiovascular mortality. Other mechanisms of low cellular cholesterol efflux may causally be involved in adverse cardiovascular outcomes.Trial registrationThe study was approved by the Ethics Committee at the “Aerztekammer Rheinland-Pfalz” and was performed conform to the declaration of Helsinki (837.255.97 [1394], approved January 8th, 1999).