Department of Nephrology, Hypertension and Family Medicine, Chair of Nephrology and Hypertension, Medical University of Lodz, 90-549 Lodz, Poland.
Int J Mol Sci. 2020 Jan 17;21(2):601. doi: 10.3390/ijms21020601.
Chronic kidney disease (CKD) is a worldwide health problem with steadily increasing occurrence. Significantly elevated cardiovascular morbidity and mortality have been observed in CKD. Cardiovascular diseases are the most important and frequent cause of death of CKD patients globally. The presence of CKD is related to disturbances in lipoprotein metabolism whose consequences are dyslipidemia and the accumulation of atherogenic particles. CKD not only fuels the reduction of high-density lipoprotein (HDL) cholesterol concentration, but also it modifies the composition of this lipoprotein. The key role of HDL is the participation in reverse cholesterol transport from peripheral tissues to the liver. Moreover, HDL prevents the oxidation of low-density lipoprotein (LDL) cholesterol by reactive oxygen species (ROS) and protects against the adverse effects of oxidized LDL (ox-LDL) on the endothelium. Numerous studies have demonstrated the ability of HDL to promote the production of nitric oxide (NO) by endothelial cells (ECs) and to exert antiapoptotic and anti-inflammatory effects. Increasing evidence suggests that in patients with chronic inflammatory disorders, HDLs may lose important antiatherosclerotic properties and become dysfunctional. So far, no therapeutic strategy to raise HDL, or alter the ratio of HDL subfractions, has been successful in slowing the progression of CKD or reducing cardiovascular disease in patients either with or without CKD.
慢性肾脏病（CKD）是一个全球性的健康问题，其发病率呈稳步上升趋势。CKD 患者的心血管发病率和死亡率显著升高。心血管疾病是全球 CKD 患者最重要和最常见的死亡原因。CKD 的存在与脂蛋白代谢紊乱有关，其后果是血脂异常和致动脉粥样硬化颗粒的积累。CKD 不仅降低了高密度脂蛋白（HDL）胆固醇的浓度，还改变了这种脂蛋白的组成。HDL 的关键作用是参与胆固醇从外周组织向肝脏的逆向转运。此外，HDL 还可以防止活性氧（ROS）氧化 LDL 胆固醇，并防止氧化 LDL（ox-LDL）对内皮细胞的不良影响。大量研究表明，HDL 能够促进内皮细胞（ECs）产生一氧化氮（NO），并发挥抗凋亡和抗炎作用。越来越多的证据表明，在患有慢性炎症性疾病的患者中，HDL 可能会失去重要的抗动脉粥样硬化特性，并变得功能失调。到目前为止，提高 HDL 或改变 HDL 亚组分比例的治疗策略都未能成功减缓 CKD 的进展，也未能降低 CKD 或非 CKD 患者的心血管疾病风险。
