Thompson Michael, Ray Udayan, Yu Richard, Hudspeth Andrew, Smillie Michael, Jordan Neville, Bartle Janet
Royal Hobart Hospital, University of Tasmania, GPO Box-1061, Hobart 7000, Australia.
J Clin Med. 2016 Mar 8;5(3):35. doi: 10.3390/jcm5030035.
Chronic kidney disease (CKD) is a potent risk factor for cardiovascular disease (CVD). CVD risk increases in a stepwise manner with increasing kidney impairment and is significantly reduced by kidney transplantation, suggesting a causal relationship. Dyslipidemia, a well recognised CVD risk factor, is highly prevalent in CKD. While dyslipidemia is a risk factor for CKD, kidney impairment can also induce a dyslipidemic state that may contribute to the excess burden of CVD in CKD. We utilised a multipronged approach to determine whether a causal relationship exists.
Retrospective case-control analysis of 816 patients admitted to the Royal Hobart Hospital in 2008-2009 with different degrees of kidney impairment and retrospective before-after cohort analysis of 60 patients who received a transplanted kidney between 1999 and 2009.
Decreased estimated GFR (eGFR) was independently associated with decreased high density lipoprotein (HDL, p < 0.0001) and increased triglyceride concentrations (p < 0.01) in multivariate analysis. There was no significant relationship between eGFR and low density lipoprotein (LDL) or total cholesterol in multivariate analysis. Kidney transplantation increased HDL (p < 0.0001) and decreased triglyceride (p = 0.007) concentration, whereas there was no significant change in LDL and total cholesterol. These effects were dependent on maintenance of graft function, statin therapy (those who were on) if graft failure occurred then HDL again decreased and triglycerides increased.
Kidney transplantation ameliorated alterations in plasma lipoprotein profile associated with kidney impairment, an effect that was dependent on the maintenance of graft function. These data suggest that kidney function is a determinant of HDL and triglyceride concentrations in patients with CKD.
慢性肾脏病（CKD）是心血管疾病（CVD）的一个重要危险因素。心血管疾病风险随着肾功能损害的加重而逐步增加，而肾移植可显著降低该风险，提示两者存在因果关系。血脂异常是一种公认的心血管疾病危险因素，在慢性肾脏病中非常普遍。虽然血脂异常是慢性肾脏病的一个危险因素，但肾功能损害也可诱发血脂异常状态，这可能导致慢性肾脏病中心血管疾病负担过重。我们采用多管齐下的方法来确定两者是否存在因果关系。
对2008 - 2009年入住皇家霍巴特医院的816例不同程度肾功能损害患者进行回顾性病例对照分析，并对1999年至2009年间接受肾移植的60例患者进行回顾性前后队列分析。
在多变量分析中，估计肾小球滤过率（eGFR）降低与高密度脂蛋白（HDL）降低（p < 0.0001）及甘油三酯浓度升高（p < 0.01）独立相关。在多变量分析中，eGFR与低密度脂蛋白（LDL）或总胆固醇之间无显著关系。肾移植可使HDL升高（p < 0.0001），甘油三酯降低（p = 0.007），而LDL和总胆固醇无显著变化。这些影响取决于移植肾功能的维持，如果发生移植失败，他汀类药物治疗（正在接受治疗者）则HDL再次降低，甘油三酯升高。
肾移植改善了与肾功能损害相关的血浆脂蛋白谱改变，这一作用取决于移植肾功能的维持。这些数据表明，肾功能是慢性肾脏病患者HDL和甘油三酯浓度的一个决定因素。
