High density lipoprotein cholesterol levels are an independent predictor of the progression of chronic kidney disease

• Autores: A. Baragetti, G.D. Norata, C. Sarcina, F. Rastelli, L. Grigore, K. Garlaschelli, Paola Uboldi, I. Baragetti, Christian Pozzi, Alberico L. Catapano
• Localización: Journal of Internal Medicine, ISSN-e 1365-2796, Vol. 274, Nº. 3, 2013, págs. 252-262
• Idioma: inglés
• Texto completo no disponible (Saber más ...)
• Resumen

  • Objectives Patients with chronic kidney disease (CKD) often present with reduced plasma HDL cholesterol (HDL-C) levels. Whether this reduction in an epiphenomenon or is involved in disease progression is unclear. The aim of this study was to investigate the relation between HDL-C levels/function and CKD progression in patients with different degrees of disease.

    Design A total of 176 patients with CKD [glomerular filtration rate (GFR) 50.3 ± 29.1 mL min−1] were recruited and followed for up to 84 months. Lipid profile, metabolic status and kidney function were evaluated at predetermined times. Age-matched control subjects were selected from the PLIC study (n = 453). Scavenger receptor class B member 1 (SR-BI) and ATP-binding cassette transporter A1 (ABCA-1)-dependent efflux of cholesterol were measured in CKD patients and in age-matched control subjects.

    Results Low HDL-C levels, diabetes and hypertension were associated with reduced GFR. At follow-up, low HDL-C levels were associated with earlier entry in dialysis or doubling of the plasma creatinine level (P = 0.017); HDL-C levels were the only lipid parameter that affected the progression of CKD (hazard ratio 0.951, 95% confidence interval 0.917–0.986, P = 0.007), independently of the presence of diabetes. Only SR-BI-mediated serum cholesterol efflux was significantly reduced in the group of CKD patients with low HDL-C levels compared to the control group.

    Conclusions CKD patients with low levels of plasma HDL-C have a poor prognosis. HDL functionality is also impaired in renal dysfunction. These data support the relevance of HDL in influencing CKD progression.