Dysfunctional high-density lipoprotein in patients on chronic hemodialysis

Suguru Yamamoto, Patricia G. Yancey, T. Alp Ikizler, W. Gray Jerome, Ryohei Kaseda, Brian Cox, Aihua Bian, Ayumi Shintani, Agnes B. Fogo, MacRae F. Linton, Sergio Fazio, Valentina Kon

    Research output: Contribution to journalArticlepeer-review

    154 Scopus citations


    Objectives: This study examined the functionality of high-density lipoprotein (HDL) in individuals with end-stage renal disease on dialysis (ESRD-HD). Background: The high rate of cardiovascular disease (CVD) in chronic kidney disease is not explained by standard risk factors, especially in patients with ESRD-HD who appear resistant to benefits of statin therapy. HDL is antiatherogenic because it extracts tissue cholesterol and reduces inflammation. Methods: Cellular cholesterol efflux and inflammatory response were assessed in macrophages exposed to HDL of patients with ESRD-HD or controls. Results: HDL from patients with ESRD-HD was dramatically less effective than normal HDL in accepting cholesterol from macrophages (median 6.9%; interquartile range [IQR]: 1.4% to 10.2%) versus control (median 14.9%; IQR: 9.8% to 17.8%; p < 0.001). The profound efflux impairment was also seen in patients with ESRD-HD and diabetes compared with patients with diabetes without renal disease (median 8.1%; IQR: 3.3% to 12.9%) versus control (median 13.6%; IQR: 11.0% to 15.9%; p = 0.009). In vitro activation of cellular cholesterol transporters increased cholesterol efflux to both normal and uremic HDL. HDL of patients with ESRD-HD had reduced antichemotactic ability and increased macrophage cytokine response (tumor necrosis factor-alpha, interleukin-6, and interleukin-1-beta). HDL of patients with ESRD-HD on statin therapy had reduced inflammatory response while maintaining impaired cholesterol acceptor function. Interestingly, impaired HDL-mediated efflux did not correlate with circulating C-reactive protein levels or cellular inflammatory response. Conclusions: These findings suggest that abnormal HDL capacity to mediate cholesterol efflux is a key driver of excess CVD in patients on chronic hemodialysis and may explain why statins have limited effect to decrease CV events. The findings also suggest cellular cholesterol transporters as potential therapeutic targets to decrease CV risk in this population.

    Original languageEnglish (US)
    Pages (from-to)2372-2379
    Number of pages8
    JournalJournal of the American College of Cardiology
    Issue number23
    StatePublished - Dec 11 2012


    • atherosclerosis
    • kidney
    • lipoprotein
    • statin

    ASJC Scopus subject areas

    • Cardiology and Cardiovascular Medicine


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