Do HDL and LDL subfractions play a role in atherosclerosis in end-stage renal disease (ESRD) patients?

Abstract

Significantly increased cardiovascular mortality in patients with chronic kidney (CKD) disease cannot be explained by traditional risk factors. Recent studies revealed that the quality of HDL and LDL cholesterol may be more important than their serum levels. The aim of this study was to assess which LDL and HDL subfractions were more abundant in end-stage renal disease (ESRD) patients and to analyse whether subfraction distribution could be associated with accelerated atherosclerotic processes. This study included 50 ESRD patients undergoing dialysis and 20 healthy volunteers. LDL and HDL subfractions were analysed in serum with the use of Lipoprint system. All patients had intima-media thickness (IMT) measured. Statistically significant differences in subfractions between control and study group were observed in case of: HDL1 (p<0.0001), HDL2 (p=0.009), HDL3 (p<0.0001), HDL4 (p=0.003), HDL5 (p=0.01), HDL7 (p<0.0001), HDL8 (p<0.0001), HDL9 (p<0.0001), HDL10 (p<0.0001), large HDL (p<0.0001), HDL Small (p<0.0001) as well as IDL-B (p=0.014), IDLA (p=0.011), LDL2 (p=0.007). Significant differences were also observed in HDL and LDL subfraction distribution between haemodialysis patients with normal and increased IMT: HDL6 (p=0.020), HDL Large (HDL1-3) (p=0.017), HDL Intermediate (HDL4-7) (p=0.017). This study revealed that ESRD influenced HDL subfractions. In HD patients, large HDL subfractions are more abundant while small HDL fraction is more frequent in healthy persons. It failed to show the influence of end-stage disease on LDL subfraction levels. Shift in HDL subfractions might be responsible for the increased risk of atherosclerosis in CKD patients.