APO(A)-ISOFORM SIZE, NUTRITIONAL-STATUS AND INFLAMMATORY MARKERS IN CHRONIC-RENAL-FAILURE

Atherosclerotic cardiovascular disease and malnutrition are widely rec ognized as leading causes of the increased morbidity and mortality obs erved in uremic patients. Levers of lipoprotein (a) [Lp(a)], an establ ished cardiovascular risk factor, are elevated in uremic patients. Mor eover, low serum albumin levels indicating malnutrition have been asso ciated with elevated plasma Lp(a) levels in dialysis patients. However , serum albumin levels are also influenced by an inflammation reaction . The present study was undertaken to further investigate the relation ship between Lp(a), inflammation and malnutrition in patients with chr onic renal failure (CRF) prior to the initiation of renal replacement therapy, and to investigate the potential relation between these facto rs and apo(a)-isoform size, an important determinant of plasma Lp(a) l evels. A total of 83 patients (mean age 52 +/- year) with terminal (cr eatinine clearance 9 +/- 1 ml/min) CRF were cross sectionally investig ated. In addition to lipid parameters and apo(a)-isoform size, C-react ive protein (CRP), nutritional parameters including serum levels of al bumin and body composition (dual energy x-ray absorptiometry), as well as a subjective global assessment (SGA) and the prevalence of cardiov ascular disease (CVD) were evaluated. Malnourished patients (N = 39) h ad a significantly (P < 0.05) higher median plasma Lp(a) level (19.5 m g/dl) as compared to 44 well-nourished patients, (11.7 mg/dl). No diff erence mas found for other lipid or lipoprotein parameters. A signific ant relationship was found between CRP and plasma Lp(a), whereas no si gnificant relation was observed between plasma Lp(a) and serum albumin levels. The apo(a)-isoform distribution was similar among malnourishe d and well-nourished patients. There was no difference in nutritional parameters when comparing patients with small-and large-size apo(a) is oforms. However, a subgroup of patients (12%) with no detectable apo(a )-bands and low Lp(a) levels had significantly higher lean body mass. The present study demonstrates elevated plasma Lp(a) levels in CRF pat ients with signs of malnutrition, even though no direct relationships between plasma Lp(a) levels and various nutritional parameters were ob served. The observed relationship between Lp(a) and CRP suggests that inflammatory factors, more prevalent in patients with malnutrition, ma y contribute to the Lp(a) increase in malnourished CRF.