J Nephrol. 1997 Jan-Feb; 10(1): 41-5.
Lp(a) levels: effects of progressive chronic renal failure and dietary manipulation.
Department of Nephrology, USL Azienda 10, Florence, Italy.
Patients with chronic renal failure (CRF) have an increased risk of cardiovascular disease (CVD). Elevated lipoprotein(a) (LP(a)) levels have been shown to be an important risk factor for CVD. This study examined Lp(a) changes during the progression of renal disease in patients following different dietary regimens. Fifty-seven patients with CRF of different etiology and degree (mean age 58 +/- 10 yrs) were divided into four groups according to their serum creatinine (sCr) levels. The first group had sCr 1.5-3; the second 3-6; the third > 6, all on a conventional low-protein diet (CLPD), and the fourth had sCr > 6 on a supplemented vegetarian diet (SVD). Lp(a), apoproteins AI, B, E, CII, CIII, CII/CIII, Apo A/Apo B ratios and the lipid pattern (total cholesterol (TC) and its fractions LDL, HDL, HDL3 and triglycerides) were investigated. Patients with diabetes, proteinuria > 1.5 g/24 h, hepatic disease or taking contraceptives or lipid lowering drugs were excluded. Results were compared with a reference group (N = 12) with sCcr < 1. Lp(a) concentrations increased with the progression of renal failure, and a significant correlation was observed with sCr. Despite the elevated sCr levels, patients on the SVD had an almost normal Lp(a) concentration. Only 15% of the reference group had Lp(a) levels > 30 mg/dl, compared to 33%, 50% and 78% of the 1st, 2nd and 3rd groups and 38% of the 4th group. No relationship was found between Lp(a), lipids or apoproteins. Our results indicate that renal function influences Lp(a) levels and suggest a SVD helps to lower them. This might be ascribed to some antioxidant factors in the SVD.