HDL in CKD-The Devil Is in the Detail

J Am Soc Nephrol. 2018 May;29(5):1356-1371. doi: 10.1681/ASN.2017070798. Epub 2018 Feb 22.

Abstract

The picture of HDL cholesterol (HDL-C) as the "good" cholesterol has eroded. This is even more surprising because there exists strong evidence that HDL-C is associated with cardiovascular disease (CVD) in the general population as well as in patients with impairment of kidney function and/or progression of CKD. However, drugs that dramatically increase HDL-C have mostly failed to decrease CVD events. Furthermore, genetic studies took the same line, as genetic variants that have a pronounced influence on HDL-C concentrations did not show an association with cardiovascular risk. For many, this was not surprising, given that an HDL particle is highly complex and carries >80 proteins and several hundred lipid species. Simply measuring cholesterol might not reflect the variety of biologic effects of heterogeneous HDL particles. Therefore, functional studies and the involvement of HDL components in the reverse cholesterol transport, including the cholesterol efflux capacity, have become a further focus of study during recent years. As also observed for other aspects, CKD populations behave differently compared with non-CKD populations. Although clear disturbances have been observed for the "functionality" of HDL particles in patients with CKD, this did not necessarily translate into clear-cut associations with outcomes.

Keywords: cardiovascular disease; cholesterol transport; high-density lipoprotein; lipids; progression of chronic renal failure; reverse.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Advanced Oxidation Protein Products / metabolism
  • Apolipoprotein A-V / metabolism
  • Apolipoprotein L1 / metabolism
  • Arginine / analogs & derivatives
  • Arginine / metabolism
  • Cardiovascular Diseases / blood
  • Cardiovascular Diseases / epidemiology*
  • Cholesterol / metabolism
  • Cholesterol, HDL / blood*
  • Cholesterol, HDL / genetics
  • Glomerular Filtration Rate / genetics
  • Humans
  • Lipid Metabolism
  • MicroRNAs
  • Renal Insufficiency, Chronic / blood*
  • Renal Insufficiency, Chronic / epidemiology*
  • Renal Insufficiency, Chronic / genetics
  • Renal Insufficiency, Chronic / physiopathology
  • Serum Amyloid A Protein / metabolism

Substances

  • APOL1 protein, human
  • Advanced Oxidation Protein Products
  • Apolipoprotein A-V
  • Apolipoprotein L1
  • Cholesterol, HDL
  • MicroRNAs
  • Serum Amyloid A Protein
  • dimethylarginine
  • symmetric dimethylarginine
  • Arginine
  • Cholesterol