Association of apolipoprotein A1 and B with kidney function and chronic kidney disease in two multiethnic population samples

Abstract

Circulating lipoproteins and their protein constituents, apolipoproteins, are risk factors for chronic kidney disease (CKD). The associations between apolipoprotein A1, apolipoprotein B and their ratio with glomerular filtration rate estimated from the new CKD Epidemiology Collaboration (CKD-EPI) equation (eGFR) are not well studied in the general population. Associations between apolipoprotein A1, B and their ratio with the outcomes of eGFR, CKD (eGFR<60 mL/min/1.73 m2) and albuminuria were examined in the Atherosclerosis Risk in Communities study (ARIC, n=10,292, 1996-98) and the Third National Health and Nutrition Examination Survey (NHANES III, n=7023, 1988-91). Cross-sectional multivariable-adjusted analyses were performed using linear and logistic regression. Prospective analyses related baseline apolipoprotein levels to subsequent CKD incidence over 10 years using the ARIC Carotid MRI follow-up cohort (n=1659). Higher apolipoprotein A1 quartiles were associated with a lower prevalence of CKD [Q4 versus Q1: odds ratio (OR) 0.73, P-trend=0.02 in ARIC; Q4 versus Q1: OR 0.53, P-trend<0.01 in NHANES III] as well as with higher eGFR (P-trend<0.01 in ARIC and NHANES III). No consistent significant associations were found for apolipoprotein B in either study. The apolipoprotein B/A1 ratio was significantly associated with eGFR across quartiles in both studies (P-trend<0.01) and with CKD in ARIC (Q4 versus Q1: OR 1.23, P-trend=0.01). Prospectively, there were trends for the association of apolipoproteins with incident CKD [Q4 versus Q1: incidence rate ratio (IRR)=0.68 for apolipoprotein A1, P-trend=0.1; Q4 versus Q1: IRR=1.35 for apolipoprotein B, P-trend=0.2]. Associations were not systematically stronger when comparing traditional lipids (total cholesterol, low-density lipoprotein or high-density lipoprotein) to apolipoproteins. Higher serum apolipoprotein A1 was associated with lower prevalence of CKD and higher eGFR estimated by the CKD-EPI equation in two large multiethnic population-based samples. While apolipoprotein B showed no consistent associations, a higher apolipoprotein B/A1 ratio was significantly associated with lower eGFR in both studies. The direction and magnitude of the longitudinal associations between apolipoproteins and CKD incidence were overall similar to those observed cross-sectionally. No consistent differences became apparent between traditional lipids and apolipoproteins.