Article Quantification of HDL Proteins, Cardiac Events, and Mortality in Patients with Type 2 Diabetes on Hemodialysis

Background and objectives Impairment of HDL function has been associated with cardiovascular events in patients with kidney failure. The protein composition of HDLs is altered in these patients, presumably compromising the cardioprotective effects of HDLs. This post hoc study assessed the relation of distinct HDL-bound proteins with cardiovascular outcomes in a dialysis population. Design, setting, participants, & measurements The concentrations of HDL-associated serum amyloid A (SAA) and surfactant protein B (SP-B) were measured in 1152 patients with type 2 diabetes mellitus on hemodialysis participating in The German Diabetes Dialysis Study whowere randomly assigned to double-blind treatment of 20mg atorvastatin daily ormatching placebo. The association of SAA(HDL) and SP-B(HDL)with cardiovascular outcomes was assessed in multivariate regression models adjusted for known clinical risk factors. ResultsHigh concentrationsof SAA(HDL)were significantly andpositively associatedwith the riskof cardiac events (hazard ratio per 1 SD higher, 1.09; 95 % confidence interval, 1.01 to 1.19). High concentrations of SP-B(HDL) were significantly associated with all-cause mortality (hazard ratio per 1 SD higher, 1.10; 95 % confidence interval, 1.02 to 1.19). Adjustment for HDL cholesterol did not affect these associations. Conclusions In patientswith diabetes on hemodialysis, SAA(HDL) and SP-B(HDL)were related to cardiac events and all-cause mortality, respectively, and they were independent of HDL cholesterol. These findings indicate that a remodeling of theHDLproteomewas associatedwith a higher risk for cardiovascular events andmortality in patients with ESRD