ELEVATED PLASMA LIPOPROTEIN(A) LEVELS AND HYPOALBUMINEMIA IN PERITONEAL-DIALYSIS PATIENTS

Plasma lipoprotein(a), Lp(a), is strongly and independently associated with atherosclerosis, and levels are elevated in hemodialysis (HD) pa tients and in some studies of those on peritoneal dialysis (PD). We hy pothesized that protein losses and hypoalbuminemia could stimulate hep atic Lp(a) synthesis, and this effect would be accentuated in PD patie nts with malnutrition. The PD subjects (n=24) had higher plasma Lp(a) levels than those (n=10) on HD (median 34.4 vs 21.0 mg/dl, p<0.05), an d values exceed normal in 62.5% vs 20% of the subjects (p<0.03), respe ctively. The serum albumin levels inversely correlated with concentrat ions of Lp(a) and apolipoprotein B, as well as the apolipoprotein B/Al ratio. In conclusion, plasma Lp(a) concentrations are frequently elev ated in PD as well as HD patients. Measuring Lp(a) levels is useful in identifying patients at increased atherogenic risk, which may not be reflected in routine lipid profiles. The negative correlation between plasma Lp(a) and albumin levels suggests that the latter may be linked pathophysiologically to hepatic Lp(a) production. The association of hypoalbuminemia with higher Lp(a) values is of particular concern beca use malnutrition frequently occurs in PD patients.