Changes in serum inflammatory markers are associated with changes in apolipoprotein A1 but not B after the initiation of dialysis

Nephrol Dial Transplant. 2014 Feb;29(2):430-7. doi: 10.1093/ndt/gft370. Epub 2013 Sep 5.


Background: Few studies have examined the changes in lipoproteins over time and how inflammation is associated with lipoprotein concentrations among patients with end-stage renal disease on dialysis. One possible explanation for the association of low LDL cholesterol concentration and adverse outcomes is that inflammation reduces selected apolipoprotein concentrations.

Methods: Serum samples were collected from a subsample of patients enrolled into the Comprehensive Dialysis Study every 3 months for up to 1 year. We examined the relation between temporal patterns in levels of inflammatory markers and changes in apolipoproteins (apo) A1 and B and the apo B/A1 ratio using linear mixed effects modeling and adjusting for potential confounders.

Results: We enrolled 266 participants from 56 dialysis facilities. The mean age was 62 years, 45% were women and 26% were black. Apo A1 was lower among patients with higher Quetelet's (body mass) index (BMI), diabetes mellitus and atherosclerosis. Apo B was lower among older patients, patients with higher serum creatinine and patients with lower BMI. Over the course of a year, apo A1 changed inversely with serum concentrations of the acute phase proteins C-reactive protein (CRP) and α1 acid glycoprotein (α1AG), while apo B did not. Changes in α1AG were more strongly associated with changes in apolipoprotein concentrations than were changes in CRP; increases in α1AG were associated with decreases in apo A1 and increases in the apo B/A1 ratio.

Conclusions: Changes in inflammatory markers were associated with changes in apo A1, but not apo B over 1 year, suggesting that reductions in high-density lipoprotein cholesterol are associated with inflammation, either of which could mediate cardiovascular risk, but not supporting a hypothesis linking increased risk of low levels of apo B containing lipoproteins to the risk associated with inflammation.

Keywords: CRP; HDL; apolipoprotein A1; apolipoprotein B; α1 acid glycoprotein.

Publication types

  • Multicenter Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Apolipoprotein A-I / blood*
  • Apolipoproteins B / blood*
  • Biomarkers / blood
  • C-Reactive Protein / metabolism*
  • Female
  • Follow-Up Studies
  • Humans
  • Inflammation / blood*
  • Kidney Failure, Chronic / blood*
  • Kidney Failure, Chronic / therapy
  • Male
  • Middle Aged
  • Prognosis
  • Prospective Studies
  • Renal Dialysis*


  • Apolipoprotein A-I
  • Apolipoproteins B
  • Biomarkers
  • C-Reactive Protein