Lipoprotein(a) is a predictor for cardiovascular mortality of hemodialysispatients

Background. Although hemodialysis (HD) patients have been associated with e levations in serum lipoprotein(a) [Lp(a)] levels, relatively little has bee n published on the link between Lp(a) and the risk for atherosclerotic card iovascular death in HD patients. Methods. Lipoprotein(a) was measured in 390 HD patients. The relationship b etween Lp(a) and mortality (overall and cardiovascular) was determined duri ng 28 months of prospective follow-up. Results. Hemodialysis patients demonstrated Lp(a) concentrations that were approximately two times as high as that of healthy controls (median, 16 vs. 8 mg/dl, P < 0.001; mean, 22.9 vs. 12.1 mg/dl, P < 0.01). Lp(a) showed a s ignificant correlation between albumin, total cholesterol, low-density lipo protein cholesterol, and C-reactive protein. The high-Lp(a) group [Lp(a) gr eater than or equal to 30 mg/dl] showed significantly higher mortality than the low-Lp(a) group [Lp(a) < 30 mg/dl] in a Kaplan-Meier survival analysis (P < 0.05). Multiple logistic regression analysis demonstrated albumin, ag e, and diabetic state as significant risk factors for overall death. Howeve r, if confined to atherosclerotic cardiovascular death, Lp(a) (P < 0.01), a ge, and diabetic state were the only independent contributors. Conclusions. Lp(a) is an independent risk factor for atherosclerotic cardio vascular death in Japanese patients receiving chronic dialysis therapy.