Yang WS, Kim SB, Min WK, Park S, Lee MS, Park JS
Atherogenic lipid profile in lipoprotein(a) in relation
to serum albumin in haemodialysis patients
Nephrol Dial Transplant
(Sep) 10:1668-1671 1995
This is a cross-sectional study of Lp(a) and other lipid levels and their
relationship to serum albumin in 101 Korean maintenance hemodialysis
patients. The results are compared with those from 46 healthy control
subjects. The important finding is that Lp(a) levels are on average 80%
higher in dialysis patients with a serum albumin less than 40 g/L as compared
those with a serum albumin greater than 40 g/L. Values in the patients with
albumin greater than 40 g/L are no different from control values. Lp(a)
been shown in the past to be predictive of cardiovascular mortality in
non-renal patients. Moreover, a number of studies have noted high
values in dialysis patients which tend to correct after successful
transplantation. This suggests that Lp(a) is affected by factors other
than genetic polymorphisms, as was originally thought to be the case.
Previous studies in dialysis patients have suggested a connection
between malnutrition and hypoalbuminemia on one hand and excess
mortality including, in particular, cardiovascular mortality on the other.
These authors therefore suggest that the unexplained link between low
albumin and high cardiac mortality may be Lp(a) levels.
Comment:: This is a provocative and interesting hypothesis.
have shown that better nourished patients have, if anything, higher
cholesterol levels but these studies did not examine Lp(a). One concern
of course is that it is difficult to differentiate the chicken and the egg
here. It may be that the cardiovascular disease causes the low serum
albumin rather than that the low serum albumin causes the
cardiovascular disease. Longer term prospective rather than
cross-sectional studies will be required to work this out. Nevertheless,
the hypothesis provided is provocative and focuses our interest on an
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