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Apolipoprotein A‐IV concentrations and clinical outcomes in a large chronic kidney disease cohort: Results from the GCKD study
BACKGROUND: Chronic kidney disease (CKD) represents a chronic proinflammatory state and is associated with very high cardiovascular risk. Apolipoprotein A‐IV (apoA‐IV) has antiatherogenic, antioxidative, anti‐inflammatory and antithrombotic properties and levels increase significantly during the cou...
Autores principales: | , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
John Wiley and Sons Inc.
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9305919/ https://www.ncbi.nlm.nih.gov/pubmed/34914850 http://dx.doi.org/10.1111/joim.13437 |
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author | Schwaiger, Johannes P. Kollerits, Barbara Steinbrenner, Inga Weissensteiner, Hansi Schönherr, Sebastian Forer, Lukas Kotsis, Fruzsina Lamina, Claudia Schneider, Markus P. Schultheiss, Ulla T. Wanner, Christoph Köttgen, Anna Eckardt, Kai‐Uwe Kronenberg, Florian |
author_facet | Schwaiger, Johannes P. Kollerits, Barbara Steinbrenner, Inga Weissensteiner, Hansi Schönherr, Sebastian Forer, Lukas Kotsis, Fruzsina Lamina, Claudia Schneider, Markus P. Schultheiss, Ulla T. Wanner, Christoph Köttgen, Anna Eckardt, Kai‐Uwe Kronenberg, Florian |
author_sort | Schwaiger, Johannes P. |
collection | PubMed |
description | BACKGROUND: Chronic kidney disease (CKD) represents a chronic proinflammatory state and is associated with very high cardiovascular risk. Apolipoprotein A‐IV (apoA‐IV) has antiatherogenic, antioxidative, anti‐inflammatory and antithrombotic properties and levels increase significantly during the course of CKD. OBJECTIVES: We aimed to investigate the association between apoA‐IV and all‐cause mortality and cardiovascular outcomes in the German Chronic Kidney Disease study. METHODS: This was a prospective cohort study including 5141 Caucasian patients with available apoA‐IV measurements and CKD. The majority of the patients had an estimated glomerular filtration rate (eGFR) of 30–60 ml/min/1.73m(2) or an eGFR >60 ml/min/1.73m(2) in the presence of overt proteinuria. Median follow‐up was 6.5 years. The association of apoA‐IV with comorbidities at baseline and endpoints during follow‐up was modelled adjusting for major confounders. RESULTS: Mean apoA‐IV concentrations of the entire cohort were 28.9 ± 9.8 mg/dl. Patients in the highest apoA‐IV quartile had the lowest high‐sensitivity C‐reactive protein values despite the highest prevalence of diabetes, albuminuria and the lowest eGFR. Each 10 mg/dl higher apoA‐IV translated into lower odds of prevalent cardiovascular disease (1289 cases, odds ratio = 0.80, 95% confidence interval [CI] 0.72–0.86, p = 0.0000003). During follow‐up, each 10 mg/dl higher apoA‐IV was significantly associated with a lower risk for all‐cause mortality (600 cases, hazard ratio [HR] = 0.81, 95% CI 0.73–0.89, p = 0.00004), incident major adverse cardiovascular events (506 cases, HR = 0.88, 95% CI 0.79–0.99, p = 0.03) and death or hospitalizations due to heart failure (346 cases, HR = 0.84, 95% CI 0.73–0.96, p = 0.01). CONCLUSIONS: These data support a link between elevated apoA‐IV concentrations and reduced inflammation in moderate CKD. ApoA‐IV appears to be an independent risk marker for reduced all‐cause mortality, cardiovascular events and heart failure in a large cohort of patients with CKD. |
format | Online Article Text |
id | pubmed-9305919 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | John Wiley and Sons Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-93059192022-07-28 Apolipoprotein A‐IV concentrations and clinical outcomes in a large chronic kidney disease cohort: Results from the GCKD study Schwaiger, Johannes P. Kollerits, Barbara Steinbrenner, Inga Weissensteiner, Hansi Schönherr, Sebastian Forer, Lukas Kotsis, Fruzsina Lamina, Claudia Schneider, Markus P. Schultheiss, Ulla T. Wanner, Christoph Köttgen, Anna Eckardt, Kai‐Uwe Kronenberg, Florian J Intern Med Original Articles BACKGROUND: Chronic kidney disease (CKD) represents a chronic proinflammatory state and is associated with very high cardiovascular risk. Apolipoprotein A‐IV (apoA‐IV) has antiatherogenic, antioxidative, anti‐inflammatory and antithrombotic properties and levels increase significantly during the course of CKD. OBJECTIVES: We aimed to investigate the association between apoA‐IV and all‐cause mortality and cardiovascular outcomes in the German Chronic Kidney Disease study. METHODS: This was a prospective cohort study including 5141 Caucasian patients with available apoA‐IV measurements and CKD. The majority of the patients had an estimated glomerular filtration rate (eGFR) of 30–60 ml/min/1.73m(2) or an eGFR >60 ml/min/1.73m(2) in the presence of overt proteinuria. Median follow‐up was 6.5 years. The association of apoA‐IV with comorbidities at baseline and endpoints during follow‐up was modelled adjusting for major confounders. RESULTS: Mean apoA‐IV concentrations of the entire cohort were 28.9 ± 9.8 mg/dl. Patients in the highest apoA‐IV quartile had the lowest high‐sensitivity C‐reactive protein values despite the highest prevalence of diabetes, albuminuria and the lowest eGFR. Each 10 mg/dl higher apoA‐IV translated into lower odds of prevalent cardiovascular disease (1289 cases, odds ratio = 0.80, 95% confidence interval [CI] 0.72–0.86, p = 0.0000003). During follow‐up, each 10 mg/dl higher apoA‐IV was significantly associated with a lower risk for all‐cause mortality (600 cases, hazard ratio [HR] = 0.81, 95% CI 0.73–0.89, p = 0.00004), incident major adverse cardiovascular events (506 cases, HR = 0.88, 95% CI 0.79–0.99, p = 0.03) and death or hospitalizations due to heart failure (346 cases, HR = 0.84, 95% CI 0.73–0.96, p = 0.01). CONCLUSIONS: These data support a link between elevated apoA‐IV concentrations and reduced inflammation in moderate CKD. ApoA‐IV appears to be an independent risk marker for reduced all‐cause mortality, cardiovascular events and heart failure in a large cohort of patients with CKD. John Wiley and Sons Inc. 2022-01-04 2022-05 /pmc/articles/PMC9305919/ /pubmed/34914850 http://dx.doi.org/10.1111/joim.13437 Text en © 2021 The Authors. Journal of Internal Medicine published by John Wiley & Sons Ltd on behalf of Association for Publication of The Journal of Internal Medicine. https://creativecommons.org/licenses/by/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Original Articles Schwaiger, Johannes P. Kollerits, Barbara Steinbrenner, Inga Weissensteiner, Hansi Schönherr, Sebastian Forer, Lukas Kotsis, Fruzsina Lamina, Claudia Schneider, Markus P. Schultheiss, Ulla T. Wanner, Christoph Köttgen, Anna Eckardt, Kai‐Uwe Kronenberg, Florian Apolipoprotein A‐IV concentrations and clinical outcomes in a large chronic kidney disease cohort: Results from the GCKD study |
title | Apolipoprotein A‐IV concentrations and clinical outcomes in a large chronic kidney disease cohort: Results from the GCKD study |
title_full | Apolipoprotein A‐IV concentrations and clinical outcomes in a large chronic kidney disease cohort: Results from the GCKD study |
title_fullStr | Apolipoprotein A‐IV concentrations and clinical outcomes in a large chronic kidney disease cohort: Results from the GCKD study |
title_full_unstemmed | Apolipoprotein A‐IV concentrations and clinical outcomes in a large chronic kidney disease cohort: Results from the GCKD study |
title_short | Apolipoprotein A‐IV concentrations and clinical outcomes in a large chronic kidney disease cohort: Results from the GCKD study |
title_sort | apolipoprotein a‐iv concentrations and clinical outcomes in a large chronic kidney disease cohort: results from the gckd study |
topic | Original Articles |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9305919/ https://www.ncbi.nlm.nih.gov/pubmed/34914850 http://dx.doi.org/10.1111/joim.13437 |
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