Cardiovascular Risk In Hemodialysis Patients Research Articles

Echocardiographic abnormalities in chronic hemodialysis patients

Introduction: Cardiovascular abnormalities are prevalent and often insidious in individuals with renal insufficiency, significantly contributing to mortality and morbidity among hemodialysis patients. Echocardiography plays a crucial role in detecting these abnormalities early, allowing for tailored interventions. This study aimed to assess the prevalence of echocardiographic findings in chronic hemodialysis patients. Methods: This descriptive study was conducted at the cardiology department of Ibn Rochd University Hospital from July 2022 to December 2023. Forty-two chronic hemodialysis patients were included, selected from ambulatory echocardiography consultations or cardiac hospitalizations. Transthoracic echocardiography examinations were performed. Results: Forty-two participants (25 women, 17 men) with an average age of 45.34 ± 13.4 years were enrolled. Left ventricular hypertrophy (LVH) was the most common abnormality, affecting 54.7% of the cohort. Valvulopathy was identified in 41% of cases, with 10% showing valve calcifications. Left ventricular dilatation was present in 29.8% of participants. Pulmonary arterial hypertension was detected in 9% of cases, and pericarditis in 3.2%. The mean systolic ejection fraction (EF) was 51.52 ± 6.02%, with 10.4% displaying systolic dysfunction of the left ventricle. Discussion: Our findings corroborate global research, underscoring LVH as the predominant anomaly. Echocardiography emerges as indispensable in identifying these abnormalities, guiding tailored interventions to mitigate cardiovascular risk in hemodialysis patients. Conclusion: Echocardiography proves invaluable in diagnosing cardiac anomalies non-invasively, offering precision and reproducibility. Given the high prevalence of cardiac-related mortality in hemodialysis patients, its integration into clinical management protocols is imperative for improved patient outcomes.

Serum alkaline phosphatase is a strong predictor of mortality in ESKD patients: analysis of the RISCAVID cohort

BackgroundMortality in hemodialysis (HD) patients remains unacceptably high compared with that of the general population and despite the continuous improvement of dialysis techniques. This study aimed to assess the role of alkaline phosphatase serum levels on cardiovascular and overall mortality in the RISCAVID study cohort through a long follow-up period, looking for associations with known risk factors for poor outcome.MethodsIn June 2004, a prospective observational study was started focusing on the cardiovascular risk in hemodialysis patients who lived in the north-west area of Tuscany (RISCAVID, “RISchio CArdiovascolare nei pazienti afferenti all’Area Vasta In Dialisi”). The RISCAVID cohort included 572 prevalent patients on maintenance HD for at least three months. Morbid or fatal events were prospectively recorded at 6-month intervals for a follow up time of 216 months.ResultsIn univariable Cox regression analysis, dialysis technique, Geriatric Nutritional Risk Index, peripheral vascular disease, and intact parathyroid hormone and total calcium serum levels were significantly associated with baseline alkaline phosphatase serum levels. Cox multivariable analysis showed that elevated serum alkaline phosphatase levels (the highest quartile), advanced age, dialysis vintage, type of vascular access, Geriatric Nutritional Risk Index, C-reactive protein and calcium serum levels, history of cardiovascular disease and peripheral vascular disease were independent predictors of overall mortality in maintenance HD patients. The fourth quartile of alkaline phosphatase was associated with all-cause 10-year mortality (HR: 1.47; 95% CI: 1.177–1.834) with a 47% increase with respect to the 1st, 2nd, and 3rd quartiles. This was also observed for 18-year all-cause mortality.ConclusionsAdjusted proportional analysis showed the alkaline phosphatase value to be an independent and powerful predictor of overall mortality in the hemodialysis population.Graphical

Serum Malondialdehyde-Modified Low-Density Lipoprotein as a Risk Marker for Peripheral Arterial Stiffness in Maintenance Hemodialysis Patients.

Background and Objectives: Peripheral arterial stiffness (PAS), assessed by brachial-ankle pulse wave velocity (baPWV), is an independent biomarker of cardiovascular diseases (CVD) in patients on maintenance hemodialysis (HD). Malondialdehyde-modified low-density lipoprotein (MDA-LDL), an oxidative stress marker, has been linked to atherosclerosis and CVD. However, the association between serum MDA-LDL and PAS among HD patients has not been fully elucidated. This study aimed to examine the association of serum MDA-LDL with PAS in HD patients and to identify the optimal cutoff value of serum MDA-LDL for predicting PAS. Materials and Methods: A cross-sectional study was conducted in 100 HD patients. Serum MDA-LDL was quantified using an enzyme-linked immunosorbent assay (ELISA), and baPWV was measured using a volume plethysmographic device. Patients were divided into the PAS group (baPWV > 18.0 m/s) and the non-PAS group (baPWV ≤ 18.0 m/s). The associations of baPWV and other clinical and biochemical parameters with serum MDA-LDL were assessed by multivariable logistic regression analyses. A receiver operating characteristic (ROC) curve analysis was performed to determine the optimal cutoff value of serum MDA-LDL for predicting PAS. Results: In multivariable logistic regression analysis, higher serum MDA-LDL, older age, and higher serum C-reactive protein [odds ratios (ORs) and 95% confidence intervals: 1.014 (1.004-1.025), 1.044 (1.004-1.085) and 3.697 (1.149-11.893)] were significantly associated with PAS. In the ROC curve analysis, the optimal cutoff value of MDA-LDL for predicting PAS was 80.91 mg/dL, with a sensitivity of 79.25% and a specificity of 59.57%. Conclusions: Greater serum MDA-LDL levels, particularly ≥80.91 mg/dL, were independently associated with PAS in HD patients. The findings suggest that oxidative stress plays a crucial role in the pathogenesis of PAS, and targeting MDA-LDL may be a potential therapeutic strategy for reducing cardiovascular risk in HD patients.

High cholesterol absorption is associated with increased cardiovascular risk in hemodialysis patients: Insights from the AURORA study

Background and Aims : Statin treatment did not reduce the risk of cardiovascular events in hemodialysis patients in the 4D and AURORA trials. Cholesterol absorption was associated with vascular risk and risk reduction by atorvastatin in the 4D study.

System of integrating biosignals during hemodialysis: the CONTINUAL (Continuous mOnitoriNg viTal sIgN dUring hemodiALysis) registry.

BackgroundAppropriate monitoring of intradialytic biosignals is essential to minimize adverse outcomes because intradialytic hypotension and arrhythmia are associated with cardiovascular risk in hemodialysis patients. However, a continuous monitoring system for intradialytic biosignals has not yet been developed.MethodsThis study investigated a cloud system that hosted a prospective, open-source registry to monitor and collect intradialytic biosignals, which was named the CONTINUAL (Continuous mOnitoriNg viTal sIgN dUring hemodiALysis) registry. This registry was based on real-time multimodal data acquisition, such as blood pressure, heart rate, electrocardiogram, and photoplethysmogram results.ResultsWe analyzed session information from this system for the initial 8 months, including data for some cases with hemodynamic complications such as intradialytic hypotension and arrhythmia.ConclusionThis biosignal registry provides valuable data that can be applied to conduct epidemiological surveys on hemodynamic complications during hemodialysis and develop artificial intelligence models that predict biosignal changes which can improve patient outcomes.

Serum concentrations of free indoxyl and p-cresyl sulfate are associated with mineral metabolism variables and cardiovascular risk in hemodialysis patients.

Indoxyl sulfate (IS) and p-cresyl sulfate (PCS) are uremic toxins associated with cardiovascular outcome in CKD patients. The present work is an analysis of the association of serum free, total IS and PCS with cardiovascular events and calcium-phosphate metabolism variables in hemodialysis patients. Serum levels of total and free IS and PCS were measured in 139 hemodialysis patients. Their relationship with calcium-phosphate metabolism variables were tested in an observational cohort study. In addition, their association with cardiovascular events was investigated during a 4-year follow-up. Patients in the highest tertile (T3) of serum free IS showed lower serum 1,25(OH)2D compared to patients in the middle (T2) and lowest tertile (T1); in addition to this, T3 patients showed lower serum irisin than T1 patients and lower serum PTH than all the other subjects (T1 + T2) combined. Serum PTH was also measured during the two years after the baseline measurement and was higher in patients in the T1 than in those in the T3 of serum free IS. Cox regression analysis showed that cardiovascular risk was lower in T1 patients than in those in the T3 of serum free PCS, both using a univariate (OR 2.55, 95% CI 1.2-5.43; p = 0.015) or multivariate model (OR 2.48, 95% CI 1.12-5.51; p = 0.003). Serum free IS may be associated with PTH and 1,25(OH)2D secretion, whereas free PCS may predict cardiovascular risk in hemodialysis patients.

Serum magnesium and zinc levels- A predictor of cardiovascular risk in hemodialysis patients

Cardiovascular disease is one of the leading causes of mortality in haemodialysis patients. Several studies have demonstrated the relation of zinc and magnesium in cardiovascular disease. In present study we aimed to measure serum zinc and magnesium levels and correlate with the Framingham score to calculate the cardiovascular risk.Present study was prospective, cross sectional type, conducted in chronic kidney disease patients undergoing haemodialysis.Serum magnesium, zinc, cholesterol, urea, creatinine, HDL cholesterol, systolic BP are measured and Framingham score was calculated. And zinc and magnesium values were correlated with Framingham score. The study is conducted in 100 CKD patients undergoing hemodialysis. Out of 100 CKD patients undergoing hemodialysis, 59% had high risk,28% had intermediate risk, and 13% had low risk of developing cardiovascular disease according to their Framingham risk score. In these patients, zinc and magnesium levels were found and correlated with Framingham risk score. Out of 100 patients undergoing hemodialysis, 37 patients were hypomagnesemic, 43 patients were normomagnesemic, 20 patients were hypermagnesemic. In this, a positive correlation was found between development of hypomagnesemia and duration of hemodialysis. Magnesium level was correlated with Framingham risk score. In this hypomagnesemic patients, 67% patients have low risk, 8% have intermediate risk, 24% patients have high risk of developing heart disease. Out of 100 patients, 86 patients have normal zinc level, 14 patients have increased zinc level. Zinc levels was not altered during dialysis. These patients already have risk of developing heart disease independent of zinc level.In our study, magnesium level of haemodialysis patients was reduced and it is associated with duration of haemodialysis. Zinc levels were not altered in the patients.

Clinical Significance of Plasma Matrix Metalloproteinase-2 and Matrix Metalloproteinase-9 Levels to Assess the Cardiovascular Risk in Hemodialysis Patients

Clinical Significance of Plasma Matrix Metalloproteinase-2 and Matrix Metalloproteinase-9 Levels to Assess the Cardiovascular Risk in Hemodialysis Patients

Efficacy of Oral Administration of Allium sativum Powder “Garlic Extract” on Lipid Profile, Inflammation, and Cardiovascular Indices among Hemodialysis Patients

Background Inflammation plays a prominent role in the deteriorating cardiovascular risk of hemodialysis patients. Utilization of herbal remedies, especially garlic extract, in these patients has resulted in promising improvement in lipid profile, inflammation, and cardiovascular markers. Purpose In this survey, we aimed to determine the effects of oral administration of Allium sativum powder on lipid profile, inflammation, and cardiovascular markers among hemodialysis patients. Methods In this interventional double-blinded randomized crossover study, 70 patients were enrolled and assigned in two groups. Each group received 300 mg of garlic powder BID or placebo for eight weeks; after a six-week wash-out period, the agents were switched between two groups so that the group who received garlic powder in the first eight weeks received placebo for the second eight weeks, and vice versa. Venous blood samples were obtained in baseline, wash-out period, and at the end of study. Following obtaining laboratory data, BUN, creatinine, Na, K, Ca, Ph, homocysteine, and lipid profile were compared. Results No significant differences were shown at baselines of outcomes between the garlic and placebo group (p value>0.05). However, there was a significant decrease in absolute values of OXLDL (mean placebo = 979.63, mean garlic = 676.54; p value<0.001) and HCY (mean placebo = 36.54, mean garlic = 27.78; p value<0.001). In addition, significant treatment differences were seen in change values of Ca (placebo = 1.17, garlic = 0.21; p value = 0.006), TG (placebo = −6.71, garlic = -24.14; p value = 0.014), OXLDL (placebo = −281.30, garlic = -699.78; p value<0.001), and HCY (placebo = −0.24, garlic = −6.68; p value<0.001). Conclusion In this study, Allium sativum powder demonstrated efficacy in lipid profile improvement and renal protective effects among hemodialysis patients.

Relation of protein energy wasting to carotid intima media thickness in hemodialysis patients.

Carotid intima media thickness (CIMT) can reflect the degree of atherosclerosis and cardiovascular risk in hemodialysis patients. Factors such as advanced age, male gender, family history, and smoking can increase the risk of CIMT. In hemodialysis (HD) patients, lower serum albumin level was found to be correlated with higher CIMT. This study aimed to evaluate the relation between CIMT and protein energy wasting (PEW) diagnosed according to the diagnostic criteria of International Society of Renal Nutrition and Metabolism (ISRNM) expert panel in HD patients. This study involved 45 HD patients who were divided into two groups according to the diagnostic criteria for PEW proposed by the ISRNM expert panel including group with PEW (11 patients) and group without PEW (34 patients). Caloric intake was evaluated by food frequency questionnaire for 3 days. Subjective global assessment (SGA) and malnutrition inflammation score (MIS) were fulfilled. Anthropometric measurements, as well as body composition, was evaluated by electrical bioimpedance analysis. Doppler ultrasonography was used to assess CIMT that was significantly higher in patients with PEW (p = 0.030). CIMT had significant positive correlation to age, SGA, and MIS (p = 0.008, 0.002, and 0.003, respectively). Significant negative correlation was observed between CIMT and serum albumin. Multiple linear regression analysis revealed that serum albumin was the only predictor of mean CIMT. In conclusion, CIMT seems to be related to malnutrition in HD patients. Low serum albumin was the only predictor of CIMT.

P1289CIRCULATING HIGH SENSITIVITY CARDIAC TROPONIN-T WAS AN IMPORTANT PREDICTIVE MARKER FOR CARDIOVASCULAR EVENTS IN HEMODIALYSIS PATIENTS

Abstract Background and Aims High sensitivity cardiac troponin-T (hs-cTnT) are prognostic markers in patients with stable cardiovascular (CV) disease but limited study investigated the CV outcome association in asymptomatic patients receiving hemodialysis (HD). We evaluated the prognostic value of hs-cTnT in predicting CV events in stable HD patients. Method A total of 341 stable HD patients was included in this prospective cohort study. Baseline hs-cTnT was measured by Roche hs-cTnT assays. Patients were followed up for 3 years or until first CV event, which was defined a composite endpoint of acute coronary syndrome, ischemic stroke, or hospitalization for heart failure. Cox proportional hazards model was used to determine independent predictors of CV events. The importance of hs-cTnT compared to other clinical parameters was evaluated by random forests algorithm in Gini index. Results The HD patients enrolled in this study was 59.2 ± 11.5 87 years old, 53.4% male, 42.5% had diabetes, 76.8% had hypertension, 17.6% had coronary artery disease, and 9.1% had cerebrovascular disease. In multivariate Cox regression analysis, the circulating hs-cTnT levels were independent associated with CV events (HR 2.31; 95% CI 1.21-4.40; p-value=0.011) after adjusting for confounders. Multivariable model showed prognostic significance, with the c-statistics of 0.75. The addition of baseline hs-cTnT to established risk factors improved risk prediction of CV events (c-statistics of 0.76; integrated discrimination improvement = 0.02, P = 0.049). Gini index demonstrated hs-cTnT was more important than other clinical parameters for CV events prediction. Conclusion Circulating hs-cTnT levels independently predicted CV events in chronic HD patients. CV risk in HD patients could be stratified according to hs-cTnT levels. The results suggest the useful property of hs-cTnT as an end-organ damage marker reflecting subclinical cardiac injury.

Calcificación de aorta abdominal de pacientes en hemodiálisis en una unidad renal

Objetivo: describir la prevalencia de calcificaciones de aorta abdominal y factores de riesgo relacionados de pacientes en hemodiálisis en una unidad renal de la ciudad de Cali. &#x0D; Introducción: las calcificaciones vasculares son prevalentes en pacientes con enfermedad renal crónica (ERC). Los pacientes en hemodiálisis presentan mayor riesgo de mortalidad cardiovascular y factores como la edad, enfermedades asociadas y algunas alteraciones metabólicas incrementan el riesgo de calcificaciones vasculares. &#x0D; Material y métodos: se incluyeron 47 pacientes en hemodiálisis mayores de 18 años y con más de tres meses en hemodiálisis. La radiografía lumbar lateral fue usada para evaluar las calcificaciones de los segmentos L1 a L4 utilizando un puntaje para su cuantificación y un único observador entrenado. Se realizaron mediciones de calcio, fósforo, PTH, colesterol, triglicéridos en sangre y tensión arterial. Fue utilizado análisis de regresión para determinar asociaciones entre las calcificaciones de aorta abdominal y las características de los pacientes. &#x0D; Resultados: se encontró que la edad promedio fue de 60,8 años (rango 25-84), el 57.4% fueron mujeres, el tiempo promedio en hemodiálisis 44.6 meses (rango 3-156). El 63.8% de los pacientes presentaron calcificaciones en algún segmento de la aorta abdominal. Se encontró que a mayor edad (P = 0.0006) y menor tensión arterial diastólica (TAD) (P = 0.036), el riesgo de prevalencia de calcificación es mayor. &#x0D; Conclusiones: la calcificación de aorta abdominal es prevalente en los pacientes con ERC en hemodiálisis. Factores como la edad y la disminución de la TAD se encontraron asociadas al grupo de calcificaciones. La radiografía lumbar lateral es una herramienta ampliamente disponible y menos costosa que puede ser tenida en cuenta en el tratamiento y evaluación de riesgo cardiovascular en los pacientes en hemodiálisis y como predictor de complicaciones

SP562Association of serum Pentraxin-3 level and Cardiovascular risk in Hemodialysis Patients

SP562Association of serum Pentraxin-3 level and Cardiovascular risk in Hemodialysis Patients

Apparent Treatment-Resistant Hypertension and Cardiovascular Risk in Hemodialysis Patients: Ten-Year Outcomes of the Q-Cohort Study

There has been limited data discussing the relationship between apparent treatment-resistant hypertension (ATRH) and cardiovascular disease risk in patients receiving maintenance hemodialysis. We analyzed data for 2999 hypertensive patients on maintenance hemodialysis. ATRH was defined as uncontrolled blood pressure despite the use of three or more classes of antihypertensive medications, or four or more classes of antihypertensive medications regardless of blood pressure level. We examined the relationships between ATRH and cardiovascular events using a Cox proportional hazards model. The proportion of participants with ATRH was 18.0% (539/2999). During follow-up (median: 106.6 months, interquartile range: 51.3–121.8 months), 931 patients experienced cardiovascular events including coronary heart disease (n = 424), hemorrhagic stroke (n = 158), ischemic stroke (n = 344), and peripheral arterial disease (n = 242). Compared with the non-ATRH group, the ATRH group showed a significant increased risk of developing cardiovascular disease (hazard ratio [HR]: 1.27; 95% confidence interval [CI]: 1.08–1.49), coronary heart disease (HR: 1.28; 95% CI: 1.01–1.62), ischemic stroke (HR: 1.31; 95% CI: 1.01–1.69), and peripheral arterial disease (HR: 1.42; 95% CI: 1.06–1.91) even after adjusting for potential confounders. This study demonstrated that ATRH was significantly associated with increased cardiovascular risk in hemodialysis patients.

Erratum to: Strong predictive value of mannose-binding lectin levels for cardiovascular risk of hemodialysis patients.

Erratum to: Strong predictive value of mannose-binding lectin levels for cardiovascular risk of hemodialysis patients.

Strong predictive value of mannose-binding lectin levels for cardiovascular risk of hemodialysis patients

BackgroundHemodialysis patients have higher rates of cardiovascular morbidity and mortality compared to the general population. Mannose-binding lectin (MBL) plays an important role in the development of cardiovascular disease. In addition, hemodialysis alters MBL concentration and functional activity. The present study determines the predictive value of MBL levels for future cardiac events (C-event), cardiovascular events (CV-event) and all-cause mortality in HD patients.MethodsWe conducted a prospective study of 107 patients on maintenance hemodialysis. Plasma MBL, properdin, C3d and sC5b-9 was measured before and after one dialysis session. The association with future C-events, CV-events, and all-cause mortality was evaluated using Cox regression models.ResultsDuring median follow-up of 27 months, 36 participants developed 21 C-events and 36 CV-events, whereas 37 patients died. The incidence of C-events and CV-events was significantly higher in patients with low MBL levels (<319 ng/mL, lower quartile). In fully adjusted models, low MBL level was independently associated with increased CV-events (hazard ratio 3.98; 95 % CI 1.88–8.24; P < 0.001) and C-events (hazard ratio 3.96; 95 % CI 1.49–10.54; P = 0.006). No association was found between low MBL levels and all-cause mortality. Furthermore, MBL substantially improved risk prediction for CV-events beyond currently used clinical markers.ConclusionsLow MBL levels are associated with a higher risk for future C-events and CV-events. Therefore, MBL levels may help to identify hemodialysis patients who are at risk to develop cardiovascular disease.Electronic supplementary materialThe online version of this article (doi:10.1186/s12967-016-0995-5) contains supplementary material, which is available to authorized users.

Creatine-kinase and dialysis patients, a helpful tool for stratifying cardiovascular risk?

Background and aimsHemodialysis patients have an enhanced risk for cardiovascular events. Cardiac biomarkers provide useful information for stratifying their risk. However the prognosis value of creatine kinase MB isoenzyme (CKMB) has not yet been validated in this population. The aim of the present study is to determine the predictable value of CK-MB in hemodialysis. MethodsA cohort of 211 hemodialysis patients (58.3% male, median age 73 (60–80) years) were followed for 39 (19–56) months. Cardiac biomarkers including CKMB were recorded at baseline. Factors associated to CKMB and prognosis value of this biomarker was studied. ResultsThe median value of CKMB was 1 (1–2) ng/mL with no patient exceeding normal laboratory values. Previous heart disease, diabetes mellitus, peripheral vascular disease and systolic and diastolic dysfunction were associated with higher levels of CKMB. Ninety-four patients (44.5%) cardiovascular events were recorded. CKMB levels ≥2ng/mL was independently associated to cardiovascular events during the follow up after adjusting. Adding CKMB to a model including several variables for predicting cardiovascular events, resulted in 17% improvement in risk discrimination (IDI) with a relative IDI of 9.9% (p=0.04). ConclusionsCKMB is a good marker for stratifying cardiovascular risk in hemodialysis patients and adds prognosis information to other well known independent predictors for cardiovascular events.

Creatine-kinase and dialysis patients, a helpful tool for stratifying cardiovascular risk?

Background and aimsHemodialysis patients have an enhanced risk for cardiovascular events. Cardiac biomarkers provide useful information for stratifying their risk. However the prognosis value of creatine kinase MB isoenzyme (CKMB) has not yet been validated in this population. The aim of the present study is to determine the predictable value of CK-MB in hemodialysis. MethodsA cohort of 211 hemodialysis patients (58.3% male, median age 73 (60–80) years) were followed for 39 (19–56) months. Cardiac biomarkers including CKMB were recorded at baseline. Factors associated to CKMB and prognosis value of this biomarker was studied. ResultsThe median value of CKMB was 1 (1–2) ng/mL with no patient exceeding normal laboratory values. Previous heart disease, diabetes mellitus, peripheral vascular disease and systolic and diastolic dysfunction were associated with higher levels of CKMB. Ninety-four patients (44.5%) cardiovascular events were recorded. CKMB levels ≥2ng/mL was independently associated to cardiovascular events during the follow up after adjusting. Adding CKMB to a model including several variables for predicting cardiovascular events, resulted in 17% improvement in risk discrimination (IDI) with a relative IDI of 9.9% (p=0.04). ConclusionsCKMB is a good marker for stratifying cardiovascular risk in hemodialysis patients and adds prognosis information to other well known independent predictors for cardiovascular events.

Intestinal Cholesterol Absorption, Treatment With Atorvastatin, and Cardiovascular Risk in Hemodialysis Patients

BackgroundHemodialysis patients are high absorbers of intestinal cholesterol; they benefit less than other patient groups from statin therapy, which inhibits cholesterol synthesis. ObjectivesThis study sought to investigate whether the individual cholesterol absorption rate affects atorvastatin’s effectiveness to reduce cardiovascular risk in hemodialysis patients. MethodsThis post-hoc analysis included 1,030 participants in the German Diabetes and Dialysis Study (4D) who were randomized to either 20 mg of atorvastatin (n = 519) or placebo (n = 511). The primary endpoint was a composite of major cardiovascular events. Secondary endpoints included all-cause mortality and all cardiac events. Tertiles of the cholestanol-to-cholesterol ratio, which is an established biomarker of cholesterol absorption, were used to identify high and low cholesterol absorbers. ResultsA total of 454 primary endpoints occurred. On multivariate time-to-event analyses, the interaction term between tertiles and treatment with atorvastatin was significantly associated with the risk of reaching the primary endpoint. Stratified analysis by cholestanol-to-cholesterol ratio tertiles confirmed this effect modification: atorvastatin reduced the risk of reaching the primary endpoint in the first tertile (hazard ratio [HR]: 0.72; p = 0.049), but not the second (HR: 0.79; p = 0.225) or third tertiles (HR: 1.21; p = 0.287). Atorvastatin consistently significantly reduced all-cause mortality and the risk of all cardiac events in only the first tertile. ConclusionsIntestinal cholesterol absorption, as reflected by cholestanol-to-cholesterol ratios, predicts the effectiveness of atorvastatin to reduce cardiovascular risk in hemodialysis patients. Those with low cholesterol absorption appear to benefit from treatment with atorvastatin, whereas those with high absorption do not benefit.

Lipoprotein profile, lipoprotein-associated phospholipase A2 and cardiovascular risk in hemodialysis patients.

Cardiovascular disease is the leading cause of morbidity and mortality in hemodialysis patients; the increased risk of cardiovascular disease is due to accelerated atherosclerosis, inflammation and impaired lipoprotein metabolism. We aimed to evaluate lipoprotein-associated phospholipase A2 (Lp-PLA2) and some pro-inflammatory aspects of the lipoprotein profile in dialyzed patients in order to evaluate the relationship with the accelerated atherosclerosis and vascular accidents. In 102 dialysis patients and 40 non-uremic controls, we investigated the lipoprotein plasma profile, high sensitivity C-reactive protein (CRP), ceruloplasmin and serum amyloid A protein (SAA), and followed patients for 1year to analyze the risk of acute cardiovascular events. Total cholesterol, low-density lipoprotein and high-density lipoprotein plasma levels were significantly lower in uremic patients than controls, whereas CRP, SAA, ceruloplasmin, Lp-PLA2 and their ratio with apolipoprotein A1 were significantly higher. Patients with Lp-PLA2 levels >194nmol/min/ml had more acute cardiovascular events than patients with lower values. Our results show that in dialysis subjects: (1) low-density lipoproteins show a more atherogenic phenotype than in the general population; (2) high-density lipoproteins are less anti-inflammatory; (3) Lp-PLA2 could potentially be used to evaluate cardiovascular risk.