The prevalence of nontraditional risk factors for coronary heart disease in patients with chronic kidney disease

Background: Risk for coronary heart disease is high among patients with chronic kidney disease. Objective: To compare the prevalence of low apolipoprotein A1 levels and elevated apolipoprotein Ell, plasma fibrinogen, lipoprotein(a), homocysteine, and C-reactive protein levels by estimated glomerular filtration rate (GFR). Design: Cross-sectional study. Setting: Third National Health and Nutrition Examination survey. Participants: 12 547, 3180, and 744 persons with estimated GFRs of at least 90, 60 to 89, or less than 60 mL/min per 1.73 m(2), respectively, who were at least 18 years of age. Measurements: Chronic kidney disease was defined as an estimated GFR of less than 60 mL/min per 1.73 m(2) based on the abbreviated Modification of Diet in Renal Disease formula. Results: After standardization for age, race or ethnicity, and sex, lower estimated GFR (greater than or equal to90, 60 to 89, or <60 mL/min per 1.73 m 2) was associated with lower average levels of apolipoprotein A1 (1.44, 1.43, and 1.35 g/L) and higher levels of apolipoprotein B (1.03, 1.06, and 1.08 g/L), plasma fibrinogen (8.43, 8.44, and 9.53 mumol/L), homocysteine (8.5, 10.0, and 13.2 mumol/L), and C-reactive protein (3.0, 2.9, and 3.9 mg/L) (P < 0.05 for all values). The multivariate-adjusted odds ratios of an apolipoprotein A1 level of less than 1.2 g/L, a serum lipoprotein(a) level of at least 1.61 mumol/L (greater than or equal to45.3 mg/dL), a plasma fibrinogen level of at least 10.35 mumol/L, a serum homocysteine level of at least 15,mumol/L, and a C-reactive protein level of at least 10.0 mg/L for participants with chronic kidney disease compared with those with a GFR of at least 90 mL/min per 1.73 m(2) or greater were 1.92 (95% Cl, 1.02 to 3.63), 1.82 (Cl, 1.06 to 3.13), 1.74 (Cl, 1.35 to 2.24), 8.23 (Cl, 5.00 to 13.6), and 1.93 (Cl, 1.33 to 2.81), respectively. Conclusions: Levels of apolipoprotein A1 are decreased and levels of homocysteine, lipoprotein(a), fibrinogen, and C-reactive protein are increased among patients with chronic kidney disease.