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ABSTRACT
In renal failure studies revealed an increase in plasma concentration of lipoprotein(a)[ Lp(a)]. Elevated plasma Lp(a) levels in chronic renal failure patients is recognized as an independent risk factor for premature atherosclerotic coronary heart disease. In this study we aimed to consider the effect of serum plasma Lp(a) levels on early structural atherosclerotic vascular changes in a group of CRF patients not yet on dialysis and end-stage renal disease patients under regular hemodialysis.This study is cross-sectional which was done on chronic renal failure (CRF) patients not being on hemodialysis yet and hemodialysis patients who were underwent regular hemodialysis because of end-stage renal failure. For patients serum Lp(a) was measured. Carotid intima-media thickness (carotid-IMT) was measured and carotidfemoral artery for plaque occurrence (plaque score) by B-mode ultrasonography was determined. Twenty-nine normal subjects (group one) (F=17 M=12), thirty-three chronic renal failure patients not yet on hemodialysis (group two)(F=19 M=14) and forty-three (F=19 M =24) hemodialysis patients due end-stage renal disease (group three) were considered. Mean±SD of LP(a) in group one were 42.0±20.0 mg/dl. The serum LP(a) of CRF group was 57.0±23.0 mg/dl and for HD group was 55.0±16.0 mg/dl. The IMT of group one was 0.84±0.20 mm.Mean±SD of IMT of CRF group and HD group were1.30±0.40 mm and 1.10±0.30 mm respectively. Ninety-three percent of persons of group one had zero plaque score while 39.4% of patients of group two and 51.2 %of patients in group three had zero plaque score more over 6.8% of subjects in group one, 24.3% in group two and 25.6% of patients in group three had plaque scores between 1&2. Also for plaque scores of 3&4, group one had zero plaque score, group two had 36.4% and group three had 23.3% plaques in scores of 3&4. Significant difference of IMT of group one with group two (p<0.001)and with group three (p=0.008) were seen. Significant difference of carotid- IMT of group two with group three p=0.023) was found too. Significant difference of LP(a) of group one with group two p=0.016) was seen and significant difference of LP(a) of group one with group three p=0.021) was demonstrated too. No significant difference of LP(a) of group two with group three (p>0.05) were found. Significant differences of plaque score between group one with group two (p<0.001) was seen also significant difference of plaque score between group one with group three (p=0.020) was found. No significant difference of plaque score of group two with group three (p>0.05) was found. Significant positive correlation of serum LP(a) with carotid- IMT and also significant positive correlation of serum LP(a) with plaque score in hemodialysis patients were found. The present study showed positive relationship of serum LP(a) with carotid- IMT and arterial plaques in hemodialysis patients. Lipoprotein(a) as a non traditional factor in progression of atherosclerosis have an important role in acceleration of atherosclerosis and cardiovascular diseases observed frequently in hemodialysis patients and needs more attention.
In renal failure studies revealed an increase in plasma concentration of lipoprotein(a)[ Lp(a)]. Elevated plasma Lp(a) levels in chronic renal failure patients is recognized as an independent risk factor for premature atherosclerotic coronary heart disease. In this study we aimed to consider the effect of serum plasma Lp(a) levels on early structural atherosclerotic vascular changes in a group of CRF patients not yet on dialysis and end-stage renal disease patients under regular hemodialysis.This study is cross-sectional which was done on chronic renal failure (CRF) patients not being on hemodialysis yet and hemodialysis patients who were underwent regular hemodialysis because of end-stage renal failure. For patients serum Lp(a) was measured. Carotid intima-media thickness (carotid-IMT) was measured and carotidfemoral artery for plaque occurrence (plaque score) by B-mode ultrasonography was determined. Twenty-nine normal subjects (group one) (F=17 M=12), thirty-three chronic renal failure patients not yet on hemodialysis (group two)(F=19 M=14) and forty-three (F=19 M =24) hemodialysis patients due end-stage renal disease (group three) were considered. Mean±SD of LP(a) in group one were 42.0±20.0 mg/dl. The serum LP(a) of CRF group was 57.0±23.0 mg/dl and for HD group was 55.0±16.0 mg/dl. The IMT of group one was 0.84±0.20 mm.Mean±SD of IMT of CRF group and HD group were1.30±0.40 mm and 1.10±0.30 mm respectively. Ninety-three percent of persons of group one had zero plaque score while 39.4% of patients of group two and 51.2 %of patients in group three had zero plaque score more over 6.8% of subjects in group one, 24.3% in group two and 25.6% of patients in group three had plaque scores between 1&2. Also for plaque scores of 3&4, group one had zero plaque score, group two had 36.4% and group three had 23.3% plaques in scores of 3&4. Significant difference of IMT of group one with group two (p<0.001)and with group three (p=0.008) were seen. Significant difference of carotid- IMT of group two with group three p=0.023) was found too. Significant difference of LP(a) of group one with group two p=0.016) was seen and significant difference of LP(a) of group one with group three p=0.021) was demonstrated too. No significant difference of LP(a) of group two with group three (p>0.05) were found. Significant differences of plaque score between group one with group two (p<0.001) was seen also significant difference of plaque score between group one with group three (p=0.020) was found. No significant difference of plaque score of group two with group three (p>0.05) was found. Significant positive correlation of serum LP(a) with carotid- IMT and also significant positive correlation of serum LP(a) with plaque score in hemodialysis patients were found. The present study showed positive relationship of serum LP(a) with carotid- IMT and arterial plaques in hemodialysis patients. Lipoprotein(a) as a non traditional factor in progression of atherosclerosis have an important role in acceleration of atherosclerosis and cardiovascular diseases observed frequently in hemodialysis patients and needs more attention.