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NDT Advance Access originally published online on May 25, 2008
Nephrology Dialysis Transplantation 2008 23(11):3599-3604; doi:10.1093/ndt/gfn296
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© The Author [2008]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org



Cholesteryl ester transfer protein activity and cardiovascular events in patients with chronic kidney disease stage V

Sarah Seiler1,*, Axel Schlitt2,*, Xian-Cheng Jiang3, Christof Ulrich1, Stefan Blankenberg4, Karl J. Lackner4, Matthias Girndt1, Karl Werdan2, Michael Buerke2, Danilo Fliser1 and Gunnar H. Heine1

1 Department of Medicine IV, Saarland University, Homburg/Saar 2 Department of Medicine III, Martin Luther University, Halle-Wittenberg, Germany 3 Department of Anatomy and Cell Biology, State University of New York, Downstate Medical Center Brooklyn, NY, USA 4 Department of Medicine II and Institute of Clinical Chemistry and Laboratory Medicine, Johannes Gutenberg University, Mainz, Germany

Correspondence and offprint requests to: Sarah Seiler, Department of Medicine IV, Saarland University, Homburg/Saar, Germany. Tel: +49-6841-1623000; Fax: +49-6841-1623545; E-mail: Sarahseiler{at}gmx.de



  Abstract

Background. Patients with chronic kidney disease (CKD) have an increased risk for cardiovascular events (CVE). Uraemic dyslipidaemia, which is characterized by low HDL-cholesterol (HDL-C) and elevated triglycerides’ levels, may contribute to this elevated cardiovascular risk. Cholesteryl ester transfer protein (CETP) lowers HDL-C by transferring cholesterol esters to LDL and VLDL particles. We tested the hypothesis that CETP activity is associated with CVE in patients with CKD stage V.

Methods. We measured CETP activity and cholesterol levels in 69 haemodialysis patients. CVE and death were prospectively assessed over a follow-up period of 48 months.

Results. CETP activity was negatively correlated with HDL-C levels in patients without lipid-lowering medication (r = –0.379, P = 0.005). We found no difference in CETP activity in patients with cardiovascular disease at baseline compared to patients without cardiovascular disease. The same was true for incident CVE during the follow-up. When stratifying patients by median CETP activity, patients with high CETP activity did not have an increased risk for CVE (P = 0.901 by the log-rank test) or death (P = 0.615). Similarly, after stratifying patients by median HDL-C no increased risk for CVE (P = 0.780) or death (P = 0.838) was found in patients with low HDL-C.

Conclusions. In summary, although CETP activity correlated with HDL-C levels, neither high CETP activity nor low HDL-C was associated with CVE in CKD stage V patients. Thus, pharmacological modification of HDL-C by CETP inhibitors seems to be of questionable value in these patients.

Keywords: CETP; chronic kidney disease; CV events; haemodialysis treatment; HDL


* Both authors contributed equally to the work.

Received for publication: 31. 1.08
Accepted in revised form: 30. 4.08


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