Small apolipoprotein(a) size predicts mortality in end-stage renal disease: The CHOICE study

J. Craig Longenecker, Michael J. Klag, Santica M. Marcovina, Neil R. Powe, Nancy E. Fink, Federico Giaculli, Josef Coresh

Research output: Contribution to journalArticlepeer-review


Background - The high mortality rate in end-stage renal disease has engendered interest in nontraditional atherosclerotic cardiovascular disease (ASCVD) risk factors that are more prevalent in end-stage renal disease, such as elevated lipoprotein(a) [Lp(a)] levels. Previous studies suggest that high Lp(a) levels and small apolipoprotein(a) [apo(a)] isoform size are associated with ASCVD, but none have investigated the relationship between Lp(a) level, apo(a) size, and mortality. Methods and Results - An inception cohort of 864 incident dialysis patients was followed prospectively. Lp(a) was measured by an apo(a) size-independent ELISA and apo(a) size by Western blot after SDS-agarose gel electrophoresis. Comorbid conditions were determined by medical record review. Time to death was ascertained through dialysis clinic and Health Care Financing Administration follow-up. Survival analyses were performed with adjustment for baseline demographic, comorbid conditions, albumin, and lipids. Median follow-up was 33.7 months, with 346 deaths, 162 transplantations, and 10 losses to follow-up during 1999 person-years of follow-up. Cox regression analysis showed no association between Lp(a) level and mortality. However, an association between small apo(a) isoform size and mortality was found (hazard ratio, 1.36; P = 0.004) after adjusting for age, race, sex, comorbidity score, cause of renal disease, and congestive heart failure. The association was somewhat lower in white patients (hazard ratio 1.34; P = 0.019) than in black patients (1.69; P = 0.04). No interaction by age, race, sex, diabetes, ASCVD, or Lp(a) level was present. Conclusions - Small apo(a) size, but not Lp(a) level, independently predicts total mortality risk in dialysis patients.

Original languageEnglish (US)
Pages (from-to)2812-2818
Number of pages7
Issue number22
StatePublished - Nov 26 2002


  • Kidney
  • Lipoproteins
  • Mortality

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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