Race-specific association of lipoprotein(a) with vascular access interventions in hemodialysis patients: The CHOICE study

Brad C. Astor, Joseph A. Eustace, Michael John Klag, Neil R. Powe, J. Craig Longenecker, Nancy E. Fink, Santica M. Marcovina, Eric B Bass

Research output: Contribution to journalArticle

Abstract

Background. Elevated serum levels of lipoprotein(a) [Lp(a)] and low molecular weight apolipoprotein(a) [apo(a)] isoforms are associated with atherothrombotic disease in the general population and in patients with kidney failure. Lp(a) may be more atherothrombotic in whites than in blacks. Data on the relation of Lp(a) and apo(a) isoform size to hemodialysis vascular access complications are limited. Methods. We analyzed the intervention-free survival of the first arteriovenous (AV) access among 215 white and 112 black incident hemodialysis patients participating in the CHOICE Study, a national multicenter prospective cohort study. Results. Median levels of Lp(a) protein were higher among blacks than whites (81.0 versus 37.5 nmol/L; P <0.001) and inversely correlated with apo(a) isoform size (r = -0.57; P <0.001). The incidence rate of access interventions was much higher in synthetic grafts (N = 193) than native fistulae (N = 134; 1.0 vs. 0.5 interventions per access-year; P <0.001) and in patients with kidney failure primarily due to diabetes mellitus (N = 161) than others (N = 166; 0.9 vs. 0.6; P <0.01), but did not differ by race. Blacks in the highest race-specific Lp(a) quartile (>145 nmol/L) had a significantly higher incidence rate than other blacks (1.4 vs. 0.7; P = 0.04), whereas no association was found in whites. The association in blacks remained after adjustment for access type and other characteristics (relative hazard = 1.68; 95% confidence interval: 0.98 to 2.86). No association was found with apo(a) isoform size in either race. Conclusions. Elevated Lp(a) may be a risk factor for arteriovenous access complications among black hemodialysis patients. Future studies should explore this possibility and be adequately powered to allow race-specific analyses.

Original languageEnglish (US)
Pages (from-to)1115-1123
Number of pages9
JournalKidney International
Volume61
Issue number3
DOIs
StatePublished - 2002

Fingerprint

Lipoprotein(a)
Blood Vessels
Renal Dialysis
Apoprotein(a)
Protein Isoforms
Molecular Weight
Renal Insufficiency
Cohort Studies
Prospective Studies
Confidence Intervals
Survival
Incidence
Serum
Population
hydroquinone
Proteins

Keywords

  • Atherothrombotic disease
  • AV access
  • Hemodialysis
  • Lipoprotein(a)
  • Thrombosis
  • Vascular access

ASJC Scopus subject areas

  • Nephrology

Cite this

Race-specific association of lipoprotein(a) with vascular access interventions in hemodialysis patients : The CHOICE study. / Astor, Brad C.; Eustace, Joseph A.; Klag, Michael John; Powe, Neil R.; Longenecker, J. Craig; Fink, Nancy E.; Marcovina, Santica M.; Bass, Eric B.

In: Kidney International, Vol. 61, No. 3, 2002, p. 1115-1123.

Research output: Contribution to journalArticle

Astor, Brad C. ; Eustace, Joseph A. ; Klag, Michael John ; Powe, Neil R. ; Longenecker, J. Craig ; Fink, Nancy E. ; Marcovina, Santica M. ; Bass, Eric B. / Race-specific association of lipoprotein(a) with vascular access interventions in hemodialysis patients : The CHOICE study. In: Kidney International. 2002 ; Vol. 61, No. 3. pp. 1115-1123.
@article{82135ef82e08476b8e8ba370b955fbdf,
title = "Race-specific association of lipoprotein(a) with vascular access interventions in hemodialysis patients: The CHOICE study",
abstract = "Background. Elevated serum levels of lipoprotein(a) [Lp(a)] and low molecular weight apolipoprotein(a) [apo(a)] isoforms are associated with atherothrombotic disease in the general population and in patients with kidney failure. Lp(a) may be more atherothrombotic in whites than in blacks. Data on the relation of Lp(a) and apo(a) isoform size to hemodialysis vascular access complications are limited. Methods. We analyzed the intervention-free survival of the first arteriovenous (AV) access among 215 white and 112 black incident hemodialysis patients participating in the CHOICE Study, a national multicenter prospective cohort study. Results. Median levels of Lp(a) protein were higher among blacks than whites (81.0 versus 37.5 nmol/L; P <0.001) and inversely correlated with apo(a) isoform size (r = -0.57; P <0.001). The incidence rate of access interventions was much higher in synthetic grafts (N = 193) than native fistulae (N = 134; 1.0 vs. 0.5 interventions per access-year; P <0.001) and in patients with kidney failure primarily due to diabetes mellitus (N = 161) than others (N = 166; 0.9 vs. 0.6; P <0.01), but did not differ by race. Blacks in the highest race-specific Lp(a) quartile (>145 nmol/L) had a significantly higher incidence rate than other blacks (1.4 vs. 0.7; P = 0.04), whereas no association was found in whites. The association in blacks remained after adjustment for access type and other characteristics (relative hazard = 1.68; 95{\%} confidence interval: 0.98 to 2.86). No association was found with apo(a) isoform size in either race. Conclusions. Elevated Lp(a) may be a risk factor for arteriovenous access complications among black hemodialysis patients. Future studies should explore this possibility and be adequately powered to allow race-specific analyses.",
keywords = "Atherothrombotic disease, AV access, Hemodialysis, Lipoprotein(a), Thrombosis, Vascular access",
author = "Astor, {Brad C.} and Eustace, {Joseph A.} and Klag, {Michael John} and Powe, {Neil R.} and Longenecker, {J. Craig} and Fink, {Nancy E.} and Marcovina, {Santica M.} and Bass, {Eric B}",
year = "2002",
doi = "10.1046/j.1523-1755.2002.00194.x",
language = "English (US)",
volume = "61",
pages = "1115--1123",
journal = "Kidney International",
issn = "0085-2538",
publisher = "Nature Publishing Group",
number = "3",

}

TY - JOUR

T1 - Race-specific association of lipoprotein(a) with vascular access interventions in hemodialysis patients

T2 - The CHOICE study

AU - Astor, Brad C.

AU - Eustace, Joseph A.

AU - Klag, Michael John

AU - Powe, Neil R.

AU - Longenecker, J. Craig

AU - Fink, Nancy E.

AU - Marcovina, Santica M.

AU - Bass, Eric B

PY - 2002

Y1 - 2002

N2 - Background. Elevated serum levels of lipoprotein(a) [Lp(a)] and low molecular weight apolipoprotein(a) [apo(a)] isoforms are associated with atherothrombotic disease in the general population and in patients with kidney failure. Lp(a) may be more atherothrombotic in whites than in blacks. Data on the relation of Lp(a) and apo(a) isoform size to hemodialysis vascular access complications are limited. Methods. We analyzed the intervention-free survival of the first arteriovenous (AV) access among 215 white and 112 black incident hemodialysis patients participating in the CHOICE Study, a national multicenter prospective cohort study. Results. Median levels of Lp(a) protein were higher among blacks than whites (81.0 versus 37.5 nmol/L; P <0.001) and inversely correlated with apo(a) isoform size (r = -0.57; P <0.001). The incidence rate of access interventions was much higher in synthetic grafts (N = 193) than native fistulae (N = 134; 1.0 vs. 0.5 interventions per access-year; P <0.001) and in patients with kidney failure primarily due to diabetes mellitus (N = 161) than others (N = 166; 0.9 vs. 0.6; P <0.01), but did not differ by race. Blacks in the highest race-specific Lp(a) quartile (>145 nmol/L) had a significantly higher incidence rate than other blacks (1.4 vs. 0.7; P = 0.04), whereas no association was found in whites. The association in blacks remained after adjustment for access type and other characteristics (relative hazard = 1.68; 95% confidence interval: 0.98 to 2.86). No association was found with apo(a) isoform size in either race. Conclusions. Elevated Lp(a) may be a risk factor for arteriovenous access complications among black hemodialysis patients. Future studies should explore this possibility and be adequately powered to allow race-specific analyses.

AB - Background. Elevated serum levels of lipoprotein(a) [Lp(a)] and low molecular weight apolipoprotein(a) [apo(a)] isoforms are associated with atherothrombotic disease in the general population and in patients with kidney failure. Lp(a) may be more atherothrombotic in whites than in blacks. Data on the relation of Lp(a) and apo(a) isoform size to hemodialysis vascular access complications are limited. Methods. We analyzed the intervention-free survival of the first arteriovenous (AV) access among 215 white and 112 black incident hemodialysis patients participating in the CHOICE Study, a national multicenter prospective cohort study. Results. Median levels of Lp(a) protein were higher among blacks than whites (81.0 versus 37.5 nmol/L; P <0.001) and inversely correlated with apo(a) isoform size (r = -0.57; P <0.001). The incidence rate of access interventions was much higher in synthetic grafts (N = 193) than native fistulae (N = 134; 1.0 vs. 0.5 interventions per access-year; P <0.001) and in patients with kidney failure primarily due to diabetes mellitus (N = 161) than others (N = 166; 0.9 vs. 0.6; P <0.01), but did not differ by race. Blacks in the highest race-specific Lp(a) quartile (>145 nmol/L) had a significantly higher incidence rate than other blacks (1.4 vs. 0.7; P = 0.04), whereas no association was found in whites. The association in blacks remained after adjustment for access type and other characteristics (relative hazard = 1.68; 95% confidence interval: 0.98 to 2.86). No association was found with apo(a) isoform size in either race. Conclusions. Elevated Lp(a) may be a risk factor for arteriovenous access complications among black hemodialysis patients. Future studies should explore this possibility and be adequately powered to allow race-specific analyses.

KW - Atherothrombotic disease

KW - AV access

KW - Hemodialysis

KW - Lipoprotein(a)

KW - Thrombosis

KW - Vascular access

UR - http://www.scopus.com/inward/record.url?scp=0036186451&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0036186451&partnerID=8YFLogxK

U2 - 10.1046/j.1523-1755.2002.00194.x

DO - 10.1046/j.1523-1755.2002.00194.x

M3 - Article

C2 - 11849466

AN - SCOPUS:0036186451

VL - 61

SP - 1115

EP - 1123

JO - Kidney International

JF - Kidney International

SN - 0085-2538

IS - 3

ER -