Apolipoprotein-B-Containing Lipoproteins and the Progression of Renal Insufficiency

Hyperlipidemia is associated with accelerated glomerular sclerosis in experimental renal insufficiency. To investigate whether the dyslipoproteinemia seen in human renal failure also influences the future course of renal insufficiency, we have correlated plasma levels of lipids and apolipoproteins at start of follow-up with the subsequent change in renal function in 34 adult patients with chronic renal disease. Nineteen patients had primary renal disease, and 15 patients had diabetic nephropathy. Except for antihypertensive therapy no specific treatment to modify the progression of the disease was given during the follow-up. The rate of progression was determined by repeated measurements of the glomerular filtration rate (GFR). The time of follow-up ranged from 12 to 91 months with an average of 39.7 ± 16.7 months. The mean initial GFR was 34.7 ± 13.9 ml/min× 1.73 m2 body surface area and the average decline in renal function was -0.27 ± 0.26 ml/min/month. The entry levels of triglycerides (TG; p = 0.04), very-low-density lipoprotein cholesterol (p = 0.03), apolipoprotein-B (ApoB; p = 0.008) and systolic blood pressure (SBP; p = 0.04) were significantly correlated with the rate of progression. Among lipoprotein variables, ApoB showed the strongest correlation with the decline in GFR. Patients with a progressive course of their disease also tended to have initially higher levels of total cholesterol (TC) and low-density lipoprotein cholesterol (NS), whereas the initial plasma concentration of high-density lipoprotein cholesterol did not show an association with the progression of renal insufficiency. The rate of progression was shown to be much higher in patients with initially high levels of both ApoB and SBP than in patients with initially low levels of these variables. There was no difference between diabetic and nondiabetic patients with respect to initial ApoB and BP levels and the rate of progression. The results of this study suggest that altered lipoprotein metabolism has a significant effect on the progression of renal failure. In particular, increased plasma concentrations of ApoB-containing lipoproteins seem to be linked to a more rapid development of renal insufficiency, and the combination of dyslipoproteinemia and hypertension may act synergistically to promote the progression of chronic renal failure.