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 to those with a serum albumin greater than 40 g/L. Values in the patients with serum albumin greater than 40 g/L are no different from control values. Lp(a) values have 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. Previous studies 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 important area. (Narsipur)

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CRF by organ system : Nutrition
CRF: Problem Areas : Outcomes (Morbidity, Mortality)