LIPOPROTEIN(A) AND VASCULAR ACCESS SURVIVAL IN PATIENTS ON CHRONIC-HEMODIALYSIS

Lipoprotein(a) [Lp(a)] is an independent risk factor for atherosclerot ic and cardiovascular complications in the general population and in h emodialysis patients. Increased Lp(a) levels have been also described as a possible predictor of vascular access occlusion in patients on ch ronic hemodialysis. We have studied prospectively: the relationship be tween vascular access survival and Lp(a) levels in 40 hemodialysis pat ients. The Lp(a) plasma concentrations were measured by enzyme-linked immunosorbent assay in all patients in April 1993. Throughout the foll owing year, evolution and survival of their vascular accesses were ana lyzed. Failure of vascular access was established when there were comp lications requiring surgical repair or transluminal angioplasty. Fourt een patients showed failure of vascular access, and the cumulative sur vival of vascular accesses after 1 year of follow-up was 63.8%. The Lp (a) levels were higher in patients with failure of vascular access tha n in the others (35.2 +/- 31 vs. 22.4 +/- 25 mg/dl), but this differen ce did not reach statistical significance (p = 0.064). The vascular ac cess survival in patients with Lp(a) levels > 75th percentile (52.5 mg /dl) was significantly lower than in the remaining patients (40 vs. 72 %; p = 0.045). This difference increased when we analyzed the patients with Lp(a) levels > 90th percentile (76 mg/dl; 25 vs. 68%; p 0.002). Our results suggest that patients with the highest levels of Lp(a) are at risk of developing complications in their vascular accesses, and t hey also have lower vascular access survival.