Lipid Abnormalities in Patients with Chronic Kidney Disease: Implications for the Pathophysiology of Atherosclerosis
Open Access
- 1 January 2013
- journal article
- review article
- Published by Japan Atherosclerosis Society in Journal of Atherosclerosis and Thrombosis
- Vol. 20 (2), 123-133
- https://doi.org/10.5551/jat.12849
Abstract
Cardiovascular disease is increased in patients with chronic kidney disease (CKD) and is the principle cause of morbidity and mortality in these patients. In patients with stage 5 CKD, structural changes in the myocardium have been implicated as the principle cardiovascular processes leading to this increase in morbidity and mortality, while atherosclerotic events including acute myocardial infarction and strokes are responsible for approximately 10-15% of cardiovascular deaths. Dyslipidemia is common in CKD patients and is usually not characterized by elevated cholesterol levels, except in patients with marked proteinuria. Increased triglyceride levels in conjunction with decreased high-density lipoprotein levels are the commonest qualitative abnormality. Characteristically, abnormalities in the metabolism of apolipoprotein (apo) B-containing lipoproteins have been described, including both gut derived (apoB-48) as well as those produced by hepatic synthesis (apoB-100). A decrease in enzymatic delipidation as well as reduced receptor removal of these lipoproteins both contribute to the increased levels of these apo-B-containing particles and their remnants (which are believed to be highly atherogenic). Abnormalities in the metabolism of apoA-containing lipoproteins are also present and these changes contribute to the lower levels of HDL seen. Qualitative abnormalities of these HDL particles may be associated with cellular oxidative injury and contribute to a pro-inflammatory, pro-thrombotic milieu that is frequently present in CKD patients.Keywords
This publication has 83 references indexed in Scilit:
- Serum Amyloid A in Uremic HDL Promotes InflammationJournal of the American Society of Nephrology, 2012
- Relationship of Estimated GFR and Coronary Artery Calcification in the CRIC (Chronic Renal Insufficiency Cohort) StudyAmerican Journal of Kidney Diseases, 2011
- The effects of lowering LDL cholesterol with simvastatin plus ezetimibe in patients with chronic kidney disease (Study of Heart and Renal Protection): a randomised placebo-controlled trialThe Lancet, 2011
- Association of estimated glomerular filtration rate and albuminuria with all-cause and cardiovascular mortality in general population cohorts: a collaborative meta-analysisThe Lancet, 2010
- Effects of Combination Lipid Therapy in Type 2 Diabetes MellitusThe New England Journal of Medicine, 2010
- Chronic kidney disease delays VLDL-apoB-100 particle catabolism: potential role of apolipoprotein C-IIIJournal of Lipid Research, 2009
- Lipoprotein(a) Concentration and the Risk of Coronary Heart Disease, Stroke, and Nonvascular MortalityJama-Journal Of The American Medical Association, 2009
- Rosuvastatin and Cardiovascular Events in Patients Undergoing HemodialysisThe New England Journal of Medicine, 2009
- Prevalence of Chronic Kidney Disease in the United StatesPublished by American Medical Association (AMA) ,2007
- Chronic Kidney Disease and the Risks of Death, Cardiovascular Events, and HospitalizationThe New England Journal of Medicine, 2004