Innovative Lipid Biomarkers and Long-Term Outcomes:studies in patients treated with renal replacement therapy and in the general population

Cardiovascular disease is the leading cause of mortality in the developed world. Atherosclerosis, the main driving factor behind cardiovascular disease, is largely influenced by lipids. Patients with a decreased kidney function, such as dialysis patients or patients who have undergone a kidney transplantation are at a particularly high risk of cardiovascular disease. Furthermore, they can develop atherosclerotic lesions in the (transplanted) kidney, leading to further function decline and eventually kidney failure. Low density lipoproteins (LDL), the ‘bad’ cholesterol, and triglycerides promote the formation of atherosclerotic plaques. High density lipoprotein (HDL), the ‘good’ cholesterol is able to break down atherosclerosis and thereby lowers the risk of cardiovascular disease. In this thesis this process was evaluated in dialysis patients, which showed that they have a decreased ability of HDL to perform this protective effect. Furthermore, a novel protective effect of HDL was described, namely the ability to lower inflammation. This protective effect indeed leads to a lower risk of cardiovascular disease in the general population. A different way of describing lipid abnormalities, by using a ratio of triglycerides to the HDL, is better at identifying patients who are at risk of cardiovascular disease of kidney disease. Furthermore, a risk score developed for cardiovascular disease is also able to predict kidney disease, which lends evidence to the fact that both processes are driven by atherosclerosis. In conclusion, this thesis identified novel biomarkers for atherosclerosis and shows how important close attention to lipid control is in both kidney disease patients and the general population