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Apolipoprotein A-IV concentrations and clinical outcomes in haemodialysis patients with type 2 diabetes mellitus: a post hoc analysis of the 4D study

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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 wa...

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Hauptverfasser: Kollerits, Barbara (VerfasserIn) , März, Winfried (VerfasserIn) , Ritz, Eberhard (VerfasserIn)
Dokumenttyp: Article (Journal)
Sprache:Englisch
Veröffentlicht: December 2012
In: Journal of internal medicine
Year: 2012, Jahrgang: 272, Heft: 6, Pages: 592-600
ISSN:1365-2796
DOI:10.1111/j.1365-2796.2012.02585.x
Online-Zugang:Verlag, Volltext: http://dx.doi.org/10.1111/j.1365-2796.2012.02585.x
Verlag, Volltext: https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1365-2796.2012.02585.x
Volltext
Verfasserangaben:B. Kollerits, V. Krane, C. Drechsler, C. Lamina, W. März, E. Ritz, C. Wanner, F. Kronenberg
Beschreibung
Zusammenfassung: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.
Beschreibung:First published: 14 August 2012
Gesehen am 23.10.2018
Beschreibung:Online Resource
ISSN:1365-2796
DOI:10.1111/j.1365-2796.2012.02585.x

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