Apolipoprotein(a) Phenotype and Lipoprotein(a) Level Predict Peritoneal Dialysis Patient Mortality

2002 ◽  
Vol 22 (4) ◽  
pp. 492-499 ◽  
Author(s):  
Eduard A. Iliescu ◽  
Santica M. Marcovina ◽  
Alexander R. Morton ◽  
Miu Lam ◽  
Marlys L. Koschinsky
Keyword(s):  
Cardiovascular Disease ◽  
Peritoneal Dialysis ◽  
Tertiary Care ◽  
Inverse Correlation ◽  
Peritoneal Dialysis Patient ◽  
Lipoprotein A ◽  
Apolipoprotein A ◽  
Size Number ◽  
Care Health

♦ Objective To examine the associations between lipoprotein(a) [Lp(a)] level, apolipoprotein(a) [apo(a)] phenotype, and patient mortality in peritoneal dialysis (PD) patients. ♦ Design Observational prospective study of prevalent PD patients. ♦ Setting Tertiary-care health sciences center. ♦ Patients 54 prevalent PD patients were followed prospectively for 24 months. ♦ Main Outcome Measures The exposures were Lp(a) level and apo(a) phenotype, designated by the apo(a) isoform size (number of kringle 4 repeats). Outcome was death from any cause. ♦ Results There were 24 deaths in 77.9 patient–years’ follow-up. The independent predictors of death in the multivariate survival analysis were age [relative risk (RR) = 1.03, p = 0.23], diabetes (RR = 3.00, p = 0.03), diastolic blood pressure ≤ 70 mmHg (RR = 2.94, p = 0.03), serum albumin (RR = 0.87, p < 0.01), and Lp(a) level (RR = 1.004, p < 0.01). There was strong inverse correlation of Lp(a) with apo(a) isoform size ( r = –0.62, p < 0.01). With Lp(a) removed from the model, apo(a) isoform size was a significant predictor of death (RR = 0.91, p = 0.0497). ♦ Conclusions Lipoprotein(a) level and apo(a) phenotype are associated with PD patient mortality. Measurement of Lp(a) level and apo(a) phenotype may be useful in clinical practice to identify patients at high risk for cardiovascular disease. Large prospective studies are needed to determine if a reversal of the increase in Lp(a) level associated with renal disease and dialysis is feasible and beneficial in reducing the risk of cardiovascular disease and mortality.

scholarly journals Lp(a) (Lipoprotein[a]) Concentrations and Incident Atherosclerotic Cardiovascular Disease

2020 ◽  
Author(s):  
Aniruddh P. Patel ◽  
Minxian Wang ◽  
James P. Pirruccello ◽  
Patrick T. Ellinor ◽  
Kenney Ng ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
South Asian ◽  
Clinical Importance ◽  
Atherosclerotic Cardiovascular Disease ◽  
Middle Aged ◽  
Lipoprotein A ◽  
Hazard Ratios ◽  
Middle Aged Adults ◽  
Relationship Of

Objective: Lipoprotein(a) concentrations are associated with atherosclerotic cardiovascular disease (ASCVD), and new therapies that enable potent and specific reduction are in development. In the largest study conducted to date, we address 3 areas of uncertainty: (1) the magnitude and shape of ASCVD risk conferred across the distribution of lipoprotein(a) concentrations; (2) variation of risk across racial and clinical subgroups; (3) clinical importance of a high lipoprotein(a) threshold to guide therapy. Approach and Results: Relationship of lipoprotein(a) to incident ASCVD studied in 460 506 middle-aged UK Biobank participants. Over a median follow-up of 11.2 years, incident ASCVD occurred in 22 401 (4.9%) participants. Median lipoprotein(a) concentration was 19.6 nmol/L (25th–75th percentile 7.6–74.8). The relationship between lipoprotein(a) and ASCVD appeared linear across the distribution, with a hazard ratio of 1.11 (95% CI, 1.10–1.12) per 50 nmol/L increment. Substantial differences in concentrations were noted according to race—median values for white, South Asian, black, and Chinese individuals were 19, 31, 75, and 16 nmol/L, respectively. However, risk per 50 nmol/L appeared similar—hazard ratios of 1.11, 1.10, and 1.07 for white, South Asian, and black individuals, respectively. A high lipoprotein(a) concentration defined as ≥150 nmol/L was present in 12.2% of those without and 20.3% of those with preexisting ASCVD and associated with hazard ratios of 1.50 (95% CI, 1.44–1.56) and 1.16 (95% CI, 1.05–1.27), respectively. Conclusions: Lipoprotein(a) concentrations predict incident ASCVD among middle-aged adults within primary and secondary prevention contexts, with a linear risk gradient across the distribution. Concentrations are variable across racial subgroups, but the associated risk appears similar.

Time-Dependent Reasons for Peritoneal Dialysis Technique Failure and Mortality

2010 ◽  
Vol 30 (2) ◽  
pp. 170-177 ◽  
Author(s):  
Inna Kolesnyk ◽  
Friedo W. Dekker ◽  
Elisabeth W. Boeschoten ◽  
Raymond T. Krediet
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Peritoneal Dialysis ◽  
The Netherlands ◽  
Patient Survival ◽  
Time Dependent ◽  
First Year ◽  
Technique Survival ◽  
Technique Failure

BackgroundPeritoneal dialysis (PD) technique failure is high compared to hemodialysis (HD). There is a lack of data on the impact of duration of PD treatment on technique survival and on whether there is a difference in risk factors with respect to early and late failure. The aim of this study was to clarify these issues by performing a time-dependent analysis of PD technique and patient survival in a large cohort of incident PD patients.MethodsWe analyzed 709 incident PD patients participating in the Netherlands Cooperative Study on the Adequacy of Dialysis (NECOSAD), who started their treatment between 1997 and 2007. We compared technique and patient survival on PD in 4 periods of follow-up: within the first 3 months, and after 3 – 12 months, 12 – 24 months, and 24 – 36 months of treatment. Cox proportional hazards model was used to analyze survival on PD and technique failure. Risk factors were also identified by comparing patients that were transferred to HD with those that remained on PD. Incidence rates for every cause of dropout for each period of follow-up were calculated to establish their trends with respect to PD treatment duration.ResultsThere was a significant increase in transplantation rate after the first year of treatment. The rate of switching to HD was highest during the first 3 months and decreased afterward. One-, 2- and 3-year technique survival was 87%, 76%, and 66%, respectively. Age, diabetes, and cardiovascular disease appeared to be risk factors for death on PD or switch to HD: a 1-year increase in age was associated with a relative risk (RR) of PD failure of 1.04 [95% confidence interval (CI) 1.003 – 1.06]; for diabetes, RR of stopping PD after 3 months of treatment increased from 1.8 (95% CI 1.1 – 3) during the first year to 2.2 (95% CI 1.3 – 4) after the second year; cardiovascular disease had a major impact in the earliest period (RR 2.5, 95% CI 1.2 – 5) and had a stable influence further on (RR 2, 95% CI 1.1 – 3.5). Loss of 1 mL/minute residual glomerular filtration rate (rGFR) appeared to be a significant predictor of PD failure after 3 months of treatment, but within the first 2 years, RR was 1.1 (95% CI 1.04 – 1.25).ConclusionsIn The Netherlands, transplantation is a main reason to stop PD treatment. The incidence of PD technique failure is at its highest during the earliest months after treatment initiation and decreases later due to fewer catheter and abdominal complications as well as less influence of psychosocial factors. Risk factors for PD discontinuation are those responsible for patient survival: age, cardiovascular disease, diabetes, and rGFR.

scholarly journals Lipoprotein(a) and Cardiovascular Disease in Ethnic Chinese: The Chin-Shan Community Cardiovascular Cohort Study

2008 ◽  
Vol 54 (2) ◽  
pp. 285-291 ◽  
Author(s):  
Kuo-Liong Chien ◽  
Hsiu-Ching Hsu ◽  
Ta-Chen Su ◽  
Fung-Chang Sung ◽  
Ming-Fong Chen ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Cohort Study ◽  
Chinese Adults ◽  
Vascular Events ◽  
Community Based ◽  
Lipoprotein A ◽  
Ethnic Chinese ◽  
Total Death ◽  
Age Range

Abstract Background: Little is known about lipoprotein(a) [Lp(a)] as a predictor of vascular events among ethnic Chinese. We prospectively investigated the association of Lp(a) with cardiovascular disease and all-cause death in a community-based cohort. Methods: We conducted a community-based prospective cohort study of 3484 participants (53% women; age range, 35–97 years) who had complete lipid measurements and were free of a cardiovascular disease history at the time of recruitment. Over a median follow-up of 13.8-years, we documented 210 cases of stroke, 122 cases of coronary heart disease (CHD), and 781 deaths. Results: The incidences for each event increased appreciably with Lp(a) quartile for stroke and all-cause death, but not for CHD. Baseline Lp(a) concentration by quartile was not significantly associated with stroke, all-cause death, and CHD in multivariate analyses. The multivariate relative risk was significant for stroke at the 90th and 95th percentiles and for total death at the 95th and 99th percentiles. Conclusions: Our findings suggest a threshold relationship with little gradient of risk across lower Lp(a) values for stroke and all-cause death in Chinese adults.

Comparison of Long-Term Survival (Beyond 12 Years) in Patients on Peritoneal Dialysis and on Hemodialysis

2003 ◽  
Vol 23 (2_suppl) ◽  
pp. 104-108 ◽  
Author(s):  
Kai-Chung Tse ◽  
Sing-Leung Lui ◽  
Wai-Kei Lo
Keyword(s):  
Cardiovascular Disease ◽  
Peritoneal Dialysis ◽  
Bone Disease ◽  
Left Ventricular ◽  
Diabetic Patients ◽  
Renal Unit ◽  
Term Survival ◽  
Long Term Survival

Objective We investigated the clinical condition and complications of patients on peritoneal dialysis (PD) and on hemodialysis (HD) for more than 12 years. Design This retrospective review was carried out in the renal unit of the Tung Wah Hospital, Hong Kong. Patients and Methods Of 103 HD and 341 PD patients who started dialysis before 1990, 14 HD and 22 PD patients were dialyzed for more than 12 years. We evaluated basic demography at the 12th year of dialysis and at the most recent follow-up, and assessed the prevalence of cardiovascular disease, bone disease, dialysis-related amyloidosis (DRA), and acquired cystic disease (ACD). Outcomes and mortality were recorded. Results The 36 patients in the study included 22 women and 14 men. The PD patients were older ( p = 0.021) and had lower levels of serum phosphate and calcium × phosphate product. Only 3 patients were diabetic. Cardiovascular disease was present in 30 patients (83.3%), the most common types being ischemic heart disease (IHD, n = 11) and left ventricular hypertrophy (LVH, n = 22). Symptomatic DRA was found in 13 patients (36.1%), more commonly in the HD group ( p = 0.014). Bone disease was present in 32 patients (88.9%), with parathyroidectomy being more frequently performed in the PD patients ( p = 0.048). Symptomatic ACD occurred in 5 patients (13.9%). At the most recent follow-up, 26 patients were still on dialysis, 3 patients had undergone renal transplantation, and 7 patients had died, the causes of death being sudden death ( n = 3), cerebrovascular accident ( n = 1), chest infection ( n = 2), and peritonitis ( n = 1). Patient survival was similar in the PD and HD groups. Age at commencement of dialysis predicted mortality ( p = 0.012), but mode of dialysis, sex, and presence of diabetes mellitus did not. Conclusions Long-term survival is possible for both dialysis modalities (PD and HD), particularly for young, non diabetic patients. Symptomatic DRA is less common in PD patients, but the prevalence of other long-term complications is similar for both groups. Cardiovascular-related problems remain the leading cause of death.

Potentially inappropriate home medications among older patients with cardiovascular disease in a Moroccan population

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
A Maaroufi ◽  
H Zahidi ◽  
S Abouradi ◽  
H Choukrani ◽  
R Habbal
Keyword(s):  
Cardiovascular Disease ◽  
Older Patients ◽  
Tertiary Care ◽  
Hormone Secretion ◽  
Multidisciplinary Teams ◽  
Potentially Inappropriate Medications ◽  
Care Hospital ◽  
Self Medication ◽  
Inappropriate Antidiuretic Hormone Secretion

Abstract Funding Acknowledgements Type of funding sources: None. Background : Patients with cardiovascular diseases use often multi-drugs regimen , which can often be associated with use of potentially inappropriate medications PIMs especially in elderly , which may pose more risks than benefits to patients and is a major factor contributing to the likelihood of serious adverse drug reactions and negative health outcomes among this population . Methods A Prospective study was conducted in a tertiary care hospital in Morocco where home medications of out patients were reviewed during follow-up consults and analyzed over three months, from October till December 2020.  Inclusion criteria were age of 65 years and above, history of cardiovascular disease.  The aim of our study was to determine the frequency and factors associated with PIMs, by applying the updated Beers 2015 criteria. Results A total of 214 patients were included in the study and were taking a total of 1498 medications at home, an average of  7 ± 3 medications per patient. The proportion of PIMS was 32 % of all medications reported, with an average of 2.2 PIM per patient, and 84% of patients were receiving at least one PIM.  Significant association was found between use of PIMs and number of home medications, female gender, self medication , and number and types of comorbidities. Comorbidities associated with more PIMs were heart failure, atrial fibrillation/flutter, rheumatological diseases, cerebrovascular accident, and insomnia/depression . The most commonly prescribed PIMs were: drugs that may exacerbate or cause syndrome of inappropriate antidiuretic hormone secretion or hyponatremia (27.3%), NSAIDs use in patients under anticoagulants (21.2%) , use of proton pump inhibitors (PPIs) &gt; 8 weeks in non-high-risk patients (10.5%), and benzodiazepines  (5.7%). Conclusions A high prevalence of PIMs in older patients with cardiovascular disease was observed. Health care giver’s education and detailed assessment of medication lists upon follow-up consults or hospital admission by multidisciplinary teams can help in preventing the use of PIMs.

scholarly journals Polymorphism in the apolipoprotein(a) gene, plasma lipoprotein(a), cardiovascular disease, and low-dose aspirin therapy

2009 ◽  
Vol 203 (2) ◽  
pp. 371-376 ◽  
Author(s):  
Daniel I. Chasman ◽  
Dov Shiffman ◽  
Robert Y.L. Zee ◽  
Judy Z. Louie ◽  
May M. Luke ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Low Dose ◽  
Aspirin Therapy ◽  
Plasma Lipoprotein ◽  
Lipoprotein A ◽  
Apolipoprotein A ◽  
Dose Aspirin ◽  
Low Dose Aspirin

Apolipoprotein(a) Phenotype, Albumin Clearance, and Plasma Levels of Lipoprotein(a) in Peritoneal Dialysis

Nephron ◽  
2001 ◽  
Vol 88 (2) ◽  
pp. 168-169 ◽  
Author(s):  
Eduard A. Iliescu ◽  
Santica M. Marcovina ◽  
Alexander R. Morton ◽  
Marlys L. Koschinsky
Keyword(s):  
Peritoneal Dialysis ◽  
Plasma Levels ◽  
Lipoprotein A ◽  
Apolipoprotein A ◽  
Albumin Clearance

scholarly journals Multicenter study of lipoprotein(a) and apolipoprotein(a) phenotypes in patients with end-stage renal disease treated by hemodialysis or continuous ambulatory peritoneal dialysis.

1995 ◽  
Vol 6 (1) ◽  
pp. 110-120
Author(s):  
F Kronenberg ◽  
P König ◽  
U Neyer ◽  
M Auinger ◽  
A Pribasnig ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Multicenter Study ◽  
Plasma Concentrations ◽  
Small Sample ◽  
Control Group ◽  
Case Control Studies ◽  
Lipoprotein A ◽  
Treatment Groups ◽  
Apolipoprotein A

Numerous studies have investigated lipoprotein(a) (Lp(a)) plasma concentrations in patients with ESRD, a patient group with an enormous risk for atherosclerosis. The reported differences in Lp(a) between controls and patients vary from a decrease of 49% to an increase of more than 1,000%. However, data are not consistent, mostly because of problems with statistical analysis, and only limited data are available for patients treated by continuous ambulatory peritoneal dialysis (CAPD). To estimate the significance of Lp(a) in ESRD and to demonstrate the statistical pitfalls concerning Lp(a) in case-control studies, a large multicenter study including 702 patients treated by either hemodialysis (HD) (N = 534) or CAPD (N = 168) was conducted, and results were compared with results from 256 healthy controls. Both patient groups showed significantly elevated Lp(a) levels in comparison with controls: 23.4 +/- 25.0 mg/dL (P < 0.005; HD) and 34.6 +/- 38.4 mg/dL (P < 0.0001; CAPD) versus 18.4 +/- 22.8 mg/dL (controls). CAPD patients showed significantly higher Lp(a) values than did patients treated by HD (P < 0.001). The difference between the two treatment groups possibly reflects an overproduction of Lp(a) to compensate for protein losses in CAPD patients. Both treatment groups included significantly more patients with Lp(a) values greater than the 75th percentile (25.6 mg/dL) of the control group (33.9 and 41.7% for HD and CAPD, respectively; P < 0.005). The higher Lp(a) values in patients were not explained by differences in isoform frequencies and the increase in Lp(a) was apolipoprotein(a) type specific: only patients with high-molecular-weight apolipoprotein(a) isoforms showed a significant elevation in Lp(a) levels. The increased plasma concentrations of Lp(a) may contribute to the high risk for atherosclerosis in ESRD, especially in patients treated by CAPD. Finally, it is believed that small sample sizes are responsible for the diverging results in Lp(a) literature.

scholarly journals Association between Aminotransferase/alanine Aminotransferase Ratio and Cardiovascular Disease mortality in Patients on Peritoneal Dialysis: A Multi-center Retrospective Study

2020 ◽  
Author(s):  
Xiaoran Feng ◽  
Yueqiang Wen ◽  
FenFen Peng ◽  
Niansong Wang ◽  
Xiaojiang Zhan ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Peritoneal Dialysis ◽  
Alanine Aminotransferase ◽  
Cox Regression ◽  
Significant Risk ◽  
Kaplan Meier ◽  
Disease Mortality ◽  
Increased Risk ◽  
Cvd Mortality

Abstract Objectives: Elevated aspartate aminotransferase/alanine aminotransferase (AST/ALT) ratio is an independent risk factor for cardiovascular disease (CVD) among the general population. However, an association between AST/ALT ratio and CVD mortality in patients on peritoneal dialysis (PD) has received little attention.Methods: A total of 2224 incident PD patients from multi-centers were enrolled from November 1, 2005, to June 30, 2017, in this retrospective cohort study. The primary endpoint was CVD mortality. Eligible patients were divided into high and normal groups according to the AST/ALT ratio cut-off for CVD mortality with the receiver operating characteristic (ROC) curve. The associations between the AST/ALT ratio and CVD mortality were evaluated by the Cox regression model.Results: Of eligible 1579 patients with a mean age of 49.3±14.6 years, 55.4% of patients were male, 18.1% of patients had diabetes, and 64.2% of patients had hypertension. The prevalence of a high AST/ALT ratio was 76.6% in the cohort population. During a follow-up period with 4659.6 patient-years, 316 patients died, of which 193 (61.1%) deaths were caused by CVD episodes. The incidence of CVD mortality in the high group was significantly higher than that in the normal group (13.1% versus 9.2%, P=0.024). Cumulative CVD mortality rates were significantly different between the two groups by Kaplan-Meier analysis [hazards ratio (HR)=1.50, 95% confidence index (CI) 1.09-2.07, P=0.014]. After adjusting for confounding factors, a higher AST/ALT ratio was independently associated with an increased risk of CVD mortality compared with their counterparts (HR=1.43, 95%CI 1.08-2.41, P=0.002). Conclusions: PD patients with high baseline AST/ALT ratio levels may be at a significant risk of CVD mortality.

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