Cardiology Department, Hospital Italiano de Buenos Aires, Perón 4190, C1199ABB, Buenos Aires, Argentina.
Facultad de Medicina, Universidad FASTA, Mar del Plata, Argentina.
J Nephrol. 2023 Jul;36(6):1549-1559. doi: 10.1007/s40620-023-01590-3. Epub 2023 Apr 8.
In the general population, high levels of lipoprotein(a) (Lp(a)) are an independent risk factor for atherosclerotic cardiovascular diseases. However, the information available in patients with chronic kidney disease (CKD) is less robust. The main objective of this updated systematic review of prospective studies was to analyze the association between elevated Lp(a) levels and cardiovascular outcomes or death in patients with CKD.
The PRISMA guidelines were used to carry out this systematic review. Randomized clinical trials or prospective observational studies that evaluated the association between Lp(a) levels and cardiovascular outcomes or death in CKD patients were searched in the current literature.
Fifteen studies including 12,260 individuals were identified and considered eligible for this systematic review. In total, 14 prospective cohorts and one post-hoc analysis of a randomized clinical trial were analyzed. Eight studies evaluated hemodialysis patients, one study analyzed patients on peritoneal dialysis, while six studies evaluated subjects with different stages of CKD. Median follow-up duration ranged from 1 to 8.6 years. Our findings showed that elevated Lp(a) values were associated with a higher risk of cardiovascular events or death in most studies, despite adjusting for traditional risk factors.
The findings of this systematic review show that there is a positive association between Lp(a) levels and fatal and non-fatal cardiovascular events in patients with CKD.
在普通人群中，脂蛋白(a)（Lp(a)）水平升高是动脉粥样硬化性心血管疾病的独立危险因素。然而，在慢性肾脏病（CKD）患者中的相关信息则不那么充分。本项针对前瞻性研究的更新系统评价的主要目的是分析 CKD 患者中升高的 Lp(a)水平与心血管结局或死亡之间的关联。
本系统评价遵循 PRISMA 指南进行。在当前文献中检索了评估 Lp(a)水平与 CKD 患者心血管结局或死亡之间关联的随机临床试验或前瞻性观察性研究。
共确定了 15 项研究，其中包括 12260 名个体，这些研究被认为符合本系统评价的标准。共有 14 项前瞻性队列研究和一项随机临床试验的事后分析被纳入分析。其中 8 项研究评估了血液透析患者，1 项研究评估了腹膜透析患者，6 项研究评估了不同阶段 CKD 的患者。中位随访时间从 1 年到 8.6 年不等。我们的研究结果表明，尽管调整了传统危险因素，但在大多数研究中，升高的 Lp(a)值与心血管事件或死亡的风险增加相关。
本系统评价的结果表明，在 CKD 患者中，Lp(a)水平与致命和非致命心血管事件之间存在正相关关系。
