Serum lipoprotein (a) associates with a higher risk of reduced renal function: a prospective investigation

Abstract

Lipoprotein (a) [Lp(a)] is a well-known risk factor for cardiovascular disease, but analysis on Lp(a) and renal dysfunction is scarce. We aimed to investigate prospectively the association of serum Lp(a) with the risk of reduced renal function, and further investigated whether diabetic or hypertensive status modified such association. Six thousand two hundred and fifty-seven Chinese adults aged ≤40 years and free of reduced renal function at baseline were included in the study. Reduced renal function was defined as estimated glomerular filtration rate <60 ml/min/1.73 m² During a mean follow-up of 4.4 years, 158 participants developed reduced renal function. Each one-unit increase in log₁₀-Lp(a) (milligrams per deciliter) was associated with a 1.99-fold (95% CI 1.15-3.43) increased risk of incident reduced renal function; the multivariable-adjusted odds ratio (OR) for the highest tertile of Lp(a) was 1.61 (95% CI 1.03-2.52) compared with the lowest tertile (P for trend = 0.03). The stratified analysis showed the association of serum Lp(a) and incident reduced renal function was more prominent in participants with prevalent diabetes [OR 4.04, 95% CI (1.42-11.54)] or hypertension [OR 2.18, 95% CI (1.22-3.89)]. A stronger association was observed in the group with diabetes and high Lp(a) (>25 mg/dl), indicating a combined effect of diabetes and high Lp(a) on the reduced renal function risk. An elevated Lp(a) level was independently associated with risk of incident reduced renal function, especially in diabetic or hypertensive patients.

Keywords: epidemiology.; hypertension; lipids; renal dysfunction; type 2 diabetes.

Fig. 1.

Association of baseline Lp(a) levels with incident reduced renal function stratified by diabetes and hypertension status. Data are ORs (95% CI) for of each one unit increase in log₁₀-Lp(a). The model was adjusted for sex, baseline age, BMI, FPG, SBP, log₁₀-TG, HDL-C, LDL-C, mildly decreased GFR, smoking and drinking status, and use of antihypertensive drugs (not for the nonhypertension strata) and antidiabetic drugs (not for the nondiabetes strata).