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Background: End-Stage renal disease is associated with accelerated atherosclerosis and a high incidence of cardiovascular disease., Methods: The serum levels of lipids and apolipoproteins and Lp(a) were determined in 51 patients with chronic renal failure (CRF) with various advancement, without interference of factors which might disturb Lp(a) metabolism and with proteinuria less than 0.5 g/24 h. The patients studied were divided into two groups: patients with moderate renal failure (CRF-M) and creatinine levels of 2-6mg/dL n = 27; and predialysis patients with end stage renal disease (ESRD) and creatinine levels higher than 8.5 mg/dL n=24., Results: In both studied groups serum concentrations of triglycerides (TG), total apoCIII, apoCIIInonB, apoB:CIII were statistically increased, (except total cholestrol (TC) and LDL-cholestrol (LDL-C), apoB, total apoE, apoEnonB, apoB:E), while the levels of HDL-cholestrol (HDL-C) and apoAl significantly decreased. Lipid and lipoprotein ratios as risk factors of atherosclerosis were similar in both groups. The TC/HDL-C ratio increased, while that of HDL-C/ apoAI and apoAI/apoCIII decreased. Serum Lp(a) concentrations were significantly increased in both studied groups. The medians and ranges of Lp(a) concentration were similar in both groups. Serum Lp(a) levels correlated with total cholesterol (r=0.295; p < 0.05), LDL-C (r = 0.312; p < 0.05) and apoB (r = 0.215; p < 0.05). In addition, no correlation was found between Lp(a) levels and albumin concentrations (r = 0.126; p = 0.421)., Conclusion: Our results may indicate that the reduced levels of apoA-containing lipoproteins and increased TG-rich apoB-containing lipoproteins and Lp(a) indicated a clear atherogenic pattern in early renal disease. Increased Lp(a) concentration may result in nonspecific synthesis or catabolism disturbances. Measurement and monitoring of lipoprotein family profiles offers a new means for selecting appropriate therapies targeted for normalizing dyslipidemia in non-dialyzed patients.

Serum lipoprotein(a) [Lp(a)] concentrations and apolipoprotein(a) apo(a) phenotypes were determined in 81 hemodialysis (HD) patients, 37 chronic ambulatory peritoneal dialysis (CAPD) patients, 25 post-transplant patients and 99 healthy subjects as the reference group. The CAPD patients had significantly higher serum Lp(a) concentration than HD patients, but both had significantly increased Lp(a) levels as compared with the reference group and post-transplant patients. When all studied groups were divided into two subgroups with at least one low molecular weight (LMW) isoform and with only one high molecular weight (HMW) isoform, they presented a similar distribution. (Pearson's chi-squared = 2,78; df = 3; p = NS). The median serum Lp(a) levels were significantly increased with HMW class versus the reference group and post-transplant patients. In CAPD patients, the LMW phenotypes showed significantly increased median serum Lp(a) concentrations versus the reference group, but they were not statistically elevated in HD patients. In the post-transplant patients, LMW and HMW phenotypes did not differ as compared to the reference group. The elevated Lp(a) levels in HD and CAPD groups were explained by apo(a) type-specific, but not by differences in, isoform frequencies. We conclude that HD and CAPD patients had increased Lp(a) levels compared with the reference group, whereas elevated Lp(a) concentrations were observed mainly in patients with HMW apo(a) phenotypes. Patients after renal transplantation showed a correction of Lp(a) levels mainly in HMW phenotypes. The LMW status corresponding to high Lp(a) levels and apo(a) isoforms could be used together with Lp(a) levels with other risk factors to assess in uremic patients the predisposition to coronary artery disease.

Serum levels of lipids, lipoprotein(a) Lp(a) and other apolipoproteins were determined in 47 predialysis patients, 40 hemodialysis (HD) patients, 39 chronic ambulatory peritoneal dialysis (CAPD) patients, 11 patients after kidney transplantation and 47 healthy subjects as reference group. The predialysis, HD, and CAPD patients had disturbances in the concentration of serum triglyceride (TG), high density lipoprotein (HDL)-cholesterol, apolipoprotein AI (apoAI), total apoCIII, apoCIII present in the particles without apoB (apoCIII non B), and Lp(a) and HDL-cholesterol, low density lipoprotein (LDL)-cholesterol/HDL-cholesterol, HDL-cholesterol/apoAI, apoAI/apoB, and apoAI/apoCIII ratios. Predialysis patients had significantly lower concentrations of HDL-cholesterol and total apoE levels than CAPD patients and total apoE level than HD patients. Moreover, both HD and CAPD patients had significantly increased levels of apoB containing apoE (apoB:E) and apoB containing apoCIII (apoB:CIII). The concentrations of serum TG, total cholesterol, LDL-cholesterol, apoB, Lp(a) in CAPD patients were statistically higher than in HD patients. The patients after transplantation demonstrated normalization of lipid and lipoprotein parameters and lipoprotein ratios except serum levels of TG, total apoCIII, apoCIII non B and the apoAI/apoCIII ratio. We concluded that abnormal lipid and lipoprotein concentrations in patients with uremia may be the cause of their high risk of atherosclerosis, but posttransplant patients exhibited improved levels of serum lipids, Lp(a) and other lipoprotein parameters and lipoprotein composition, which could be an index of decreased atherogenic status.