Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
SHR Neuro Krebs Kardio Lipid Stoffw Microb
Kollerits, B; Krane, V; Drechsler, C; Lamina, C; März, W; Ritz, E; Wanner, C; Kronenberg, F; German Diabetes and Dialysis Study Investigators.
Apolipoprotein A-IV concentrations and clinical outcomes in haemodialysis patients with type 2 diabetes mellitus--a post hoc analysis of the 4D Study.
J Intern Med. 2012; 272(6):592-600
Doi: 10.1111/j.1365-2796.2012.02585.x
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- Co-Autor*innen der Med Uni Graz
- März Winfried
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- Abstract:
- 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. 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. 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. 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. © 2012 The Association for the Publication of the Journal of Internal Medicine.
- Find related publications in this database (using NLM MeSH Indexing)
- Adult -
- Age Factors -
- Aged -
- Aged, 80 and over -
- Antioxidants - metabolism
- Apolipoproteins A - blood
- Body Mass Index -
- Cardiovascular Diseases - etiology
- Cardiovascular Diseases - mortality
- Cardiovascular Diseases - prevention & control
- Carrier Proteins - blood
- Diabetes Mellitus, Type 2 - complications
- Diabetes Mellitus, Type 2 - mortality
- Energy Metabolism -
- Epidemiologic Methods -
- Female -
- Female - epidemiology
- Humans -
- Kidney Failure, Chronic - blood
- Kidney Failure, Chronic - etiology
- Kidney Failure, Chronic - mortality
- Kidney Failure, Chronic - therapy
- Male -
- Middle Aged -
- Nutritional Status -
- Outcome and Process Assessment (Health Care) -
- Proportional Hazards Models -
- Renal Dialysis - mortality
- Renal Dialysis - statistics & numerical data
- Sex Factors -
- Young Adult -
- Find related publications in this database (Keywords)
- all-cause mortality
- apolipoprotein A-IV
- haemodialysis
- nutrition
- protein-energy wasting