Chronic kidney disease stage affects small, dense low-density lipoprotein but not glycated low-density lipoprotein in younger chronic kidney disease patients: a cross-sectional study

Guido Filler, Sepideh Taheri, Christopher McIntyre, Connor Smith, Lakshmimathy Subramanian, Gerhard Fusch, Christoph Fusch, Guido Filler, Sepideh Taheri, Christopher McIntyre, Connor Smith, Lakshmimathy Subramanian, Gerhard Fusch, Christoph Fusch

Abstract

Background: Small, dense low-density lipoprotein (sd-LDL) and glycated LDL (g-LDL) have been associated with cardiovascular disease (CVD) in chronic kidney disease (CKD) in patients >60 years of age. Since young adult and paediatric patients have shorter exposure to Framingham-type risk factors, our study aims to determine whether younger CKD patients exhibit the same sd-LDL and g-LDL pattern.

Methods: After ethics board approval, this cross-sectional study was conducted at two universities with 44 patients (mean ± standard deviation age 12.6 ± 4.9, range 2-24 years) with CKD stage of 1-5. Laboratory parameters studied were Cystatin C (CysC), CysC estimated glomerular filtration rate (eGFR) (calculated from the Filler formula), sd-LDL, g-LDL and albumin. Lipid samples were measured for sd-LDL and g-LDL using ELISA. Non-linear correlation analysis was performed to determine the relationship between g-LDL, sd-LDL and eGFR. Clinical Trials Registration is at clinicaltrials.gov, NCT02126293, https://ichgcp.net/clinical-trials-registry/NCT02126293.

Results: Triglycerides, but not total cholesterol and calculated LDL, were associated with CKD stages (ANOVA P = 0.0091). As in adults, sd-LDL was significantly associated with CKD stages (ANOVA P = 0.0133), CysC eGFR (r = -0.6495, P < 0.00001), and body mass index (r = -0.3895, P = 0.0189), but not with age. By contrast, there was no significant correlation between g-LDL and CKD stages or CysC eGFR (P = 0.9678).

Conclusions: Our study demonstrates that only triglycerides and sd-LDL were associated with CKD stages in this young cohort without confounding Framingham-type CVD risk factors. While larger studies are needed, this study suggests that lowering sd-LDL levels may be a potential target to ameliorate the long-term CVD risks in paediatric CKD patients.

Keywords: Framingham-type risk factors; cardiovascular risk; chronic kidney disease; disordered lipids; small dense LDL; triglycerides.

Figures

Fig. 1.
Fig. 1.
Lipid parameters by CKD stage.
Fig. 2.
Fig. 2.
sd- and g-LDL versus CysC eGFR using the Filler formula [18]. Average age (± 1 SD) was 14.1 ± 2.5 years for CKD Stage 1; 11.1 ± 3.6 years for CKD Stage 2; 12.3 ± 4.3 years for CKD Stage 3; 20.4 ± 6.5 for CKD Stage 4; and 13.8 ± 5.9 years for CKD Stage 5.

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