Nephrology Dialysis Transplantation, Vol 12, Issue 9 1908-1915, Copyright © 1997 by Oxford University Press
O Samuelsson, H Mulec, C Knight-Gibson, P Attman, B Kron, R Larrson, L Weiss, H Wedel and P Alaupovic
Background. Chronic renal insufficiency is accompanied
by specific alterations of the lipoprotein metabolism. It has been
suggested that the renal dyslipoproteinaemia of renal insufficiency
contributes to the progression of glomerular and tubular lesions, with
subsequent deterioration of renal function. The objective of this
prospective study was to investigate whether the specific lipoprotein
abnormalities of renal insufficiency are associated with the rate of
decline of renal function in patients with moderately advanced chronic
renal failure. Methods. A patient population of 73
adult non-diabetic patients with primary chronic renal disease were
followed with repeated measurements of glomerular filtration rate (GFR) for
an average of 3.2 (SD 0.7) years. Forty-three of these patients had chronic
glomerulonephritis as the underlying renal disease. Patient characteristics
including plasma levels of lipids and apolipoproteins were determined at
entry and were prospectively related, using linear regression, to the rate
of progression. Results. The mean GFR at entry was
41.3 (SD 15.3) ml/min x 1.73 m2 BSA. The average
rate of progression was a decline in GFR of -2.8 (SD 3.7) ml/min x 1.73
m2 BSA per year. In the whole patient study group
total cholesterol, low-density lipoprotein (LDL) cholesterol, and
apolipoprotein B (apoB) were all significantly associated with a more rapid
decline in renal function, whereas triglycerides, high-density lipoprotein
(HDL) cholesterol, and apolipoprotein A (apoA) were not. In the more
homogeneous subgroup of patients with chronic glomerulonephritis the
association between dyslipidaemia and the rate of progression was even more
pronounced. In this subgroup of patients also serum triglycerides and apoE
were significantly associated with a higher rate of progression. Both the
initial blood pressure and proteinuria were also significantly associated
with a more rapid decline in renal function in the whole study group as
well as in patients with chronic glomerulonephritis. The associations
between these variables with the rate of progression were all independent
of the entry GFR values. Conclusions. These results
indicate that the lipoprotein abnormalities of renal insufficiency
contribute to the progression of renal failure in human chronic renal
disease. Keywords: lipids; apolipoproteins; chronic
renal disease; glomerular filtration rate; progression
ORIGINAL ARTICLES
Lipoprotein abnormalities are associated with increased rate of progression of human chronic renal insufficiency
Department of Nephrology, University of Goteborg, Goteborg, Sweden; Lipid and Lipoprotein Laboratory, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA; Department of Epidemiology and Biostatistics, Nordic School of Public Health, Goteborg, Sweden; Corresponding author at: Department of Nephrology, Sahlgrenska Sjukhuset, S-413 45 Goteborg, Sweden
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