Lipoprotein(a) is a predictor for cardiovascular mortality of hemodialysis patients

Lipoprotein(a) is a predictor for cardiovascular mortality of hemodialysis patients.BackgroundAlthough hemodialysis (HD) patients have been associated with elevations in serum lipoprotein(a) [Lp(a)] levels, relatively little has been published on the link between Lp(a) and the risk for atherosclerotic cardiovascular death in HD patients.MethodsLipoprotein(a) was measured in 390 HD patients. The relationship between Lp(a) and mortality (overall and cardiovascular) was determined during 28 months of prospective follow-up.ResultsHemodialysis patients demonstrated Lp(a) concentrations that were approximately two times as high as that of healthy controls (median, 16 vs. 8 mg/dl, P < 0.001; mean, 22.9 vs. 12.1 mg/dl, P < 0.01). Lp(a) showed a significant correlation between albumin, total cholesterol, low-density lipoprotein cholesterol, and C-reactive protein. The high-Lp(a) group [Lp(a) ≥ 30 mg/dl] showed significantly higher mortality than the low-Lp(a) group [Lp(a) < 30 mg/dl] in a Kaplan–Meier survival analysis (P < 0.05). Multiple logistic regression analysis demonstrated albumin, age, and diabetic state as significant risk factors for overall death. However, if confined to atherosclerotic cardiovascular death, Lp(a) (P < 0.01), age, and diabetic state were the only independent contributors.ConclusionsLp(a) is an independent risk factor for atherosclerotic cardiovascular death in Japanese patients receiving chronic dialysis therapy

Switch from conventional to high-flux membrane reduces the risk of carpal tunnel syndrome and mortality of hemodialysis patients

Switch from conventional to high-flux membrane reduces the risk of carpal tunnel syndrome and mortality of hemodialysis patients. The use of a high-flux membrane, which eliminates larger molecular weight solutes with better biocompatibility, has steadily increased since the discovery of beta-2 microglobulin (β2m) amyloidosis in 1985. The long-term effects of a dialyzer membrane on morbidity and mortality are not completely understood. To examine the membrane effect as a factor of carpal tunnel syndrome onset and mortality, multivariate Cox regression analysis with time-dependent covariate was conducted on 819 patients from March 1968 to November 1994 at a single center. Two hundred and forty-eight of the patients were either switched from the conventional to high-flux membrane or treated only with a high-flux membrane. Fifty-one patients underwent a CTS operation and 206 died. Membrane status (on high-flux or on conventional) was considered as time-dependent covariate and risk was adjusted for age, gender, type of renal disease and calendar year of dialysis initiation. The relative risk of CTS was reduced to 0.503 (P < 0.05) and mortality 0.613 (P < 0.05) by dialysis on the high-flux membrane, compared to the conventional membrane. Serial measurements of β2m indicated significantly lower β2m to persist in patients on the high-flux membrane. The high-flux membrane decreased the risk of morbidity and mortality substantially. Larger molecule elimination was shown important not only for preventing β2m amyloidosis, but for prolonging survival of dialysis patients as well