Apolipoprotein A-IV concentrations and clinical outcomes in haemodialysis patients with type 2 diabetes mellitus

• Verfasst von: Kollerits, Barbara [VerfasserIn]
• Verfasst von: März, Winfried [VerfasserIn]
• Verfasst von: Ritz, Eberhard [VerfasserIn]
• Titel: Apolipoprotein A-IV concentrations and clinical outcomes in haemodialysis patients with type 2 diabetes mellitus
• Titelzusatz: a post hoc analysis of the 4D study
• Verf.angabe: B. Kollerits, V. Krane, C. Drechsler, C. Lamina, W. März, E. Ritz, C. Wanner, F. Kronenberg
• E-Jahr: 2012
• Jahr: December 2012
• Umfang: 9 S.
• Fussnoten: First published: 14 August 2012 ; Gesehen am 23.10.2018
• Titel Quelle: Enthalten in: Journal of internal medicine
• Ort Quelle: Oxford [u.a.] : Wiley-Blackwell, 1863
• Jahr Quelle: 2012
• Band/Heft Quelle: 272(2012), 6, Seite 592-600
• ISSN Quelle: 1365-2796
• DOI: doi:10.1111/j.1365-2796.2012.02585.x
• Datenträger: Online-Ressource
• Sprache: eng
• Bibliogr. Hinweis: Erscheint auch als : Druck-Ausgabe: Apolipoprotein A-IV concentrations and clinical outcomes in haemodialysis patients with type 2 diabetes mellitus. - 2012
• Sach-SW: all-cause mortality
• Sach-SW: apolipoprotein A-IV
• Sach-SW: haemodialysis
• Sach-SW: nutrition
• Sach-SW: protein-energy wasting
• K10plus-PPN: 158221901X

Abstract

Background Apolipoprotein A-IV (apoA-IV) is an anti-atherogenic and anti-oxidative plasma glycoprotein involved in reverse cholesterol transport. The aim of this study was to examine the association between apoA-IV and all-cause mortality, cardiovascular endpoints and parameters of protein-energy wasting and nutrition in haemodialysis patients. Methods This post hoc analysis was performed in the German Diabetes Dialysis Study (4D Study) evaluating atorvastatin in 1255 haemodialysis patients with type 2 diabetes mellitus, followed for a median of 4 years. The association between apoA-IV and relevant outcomes was analysed using Cox proportional hazards regression analyses. Body mass index (BMI) was used as a marker of protein-energy wasting. In addition, a definition of extended wasting was applied, combining median values of BMI, serum albumin, creatinine and sensitive C-reactive protein, to classify patients. Results Mean (±SD) apoA-IV concentration was 49.8 ± 14.2 mg dL−1. Age- and gender-adjusted apoA-IV concentrations were strongly associated with the presence of congestive heart failure at baseline [odds ratio = 0.81, 95% confidence interval (CI) 0.74-0.88 per 10 mg dL−1 increase; P < 0.001). During the prospective follow-up, the strongest association was found for all-cause mortality [hazard ratio (HR) = 0.89, 95% CI 0.85-0.95, P = 0.001), which was mainly because of patients with BMI > 23 kg m−2 (HR = 0.87, 95% CI 0.82-0.94, P < 0.001) and those in the nonwasting group according to the extended definition (HR = 0.89, 95% CI 0.84-0.96, P = 0.001). This association remained significant after additionally adjusting for parameters associated with apoA-IV at baseline. Further associations were observed for sudden cardiac death. ApoA-IV was less strongly associated with atherogenic events such as myocardial infarction. Conclusions Low apoA-IV levels seem to be a risk predictor of all-cause mortality and sudden cardiac death. This association might be modified by nutritional status.