Abstract | BACKGROUND: METHODS: We analyzed the intervention-free survival of the first arteriovenous (AV) access among 215 white and 112 black incident hemodialysis patients participating in the CHOICE Study, a national multicenter prospective cohort study. RESULTS: Median levels of Lp(a) protein were higher among blacks than whites (81.0 versus 37.5 nmol/L; P < 0.001) and inversely correlated with apo(a) isoform size (r = -0.57; P < 0.001). The incidence rate of access interventions was much higher in synthetic grafts (N = 193) than native fistulae (N = 134; 1.0 vs. 0.5 interventions per access-year; P < 0.001) and in patients with kidney failure primarily due to diabetes mellitus (N = 161) than others (N = 166; 0.9 vs. 0.6; P < 0.01), but did not differ by race. Blacks in the highest race-specific Lp(a) quartile (>145 nmol/L) had a significantly higher incidence rate than other blacks (1.4 vs. 0.7; P = 0.04), whereas no association was found in whites. The association in blacks remained after adjustment for access type and other characteristics (relative hazard = 1.68; 95% confidence interval: 0.98 to 2.86). No association was found with apo(a) isoform size in either race. CONCLUSIONS: Elevated Lp(a) may be a risk factor for arteriovenous access complications among black hemodialysis patients. Future studies should explore this possibility and be adequately powered to allow race-specific analyses.
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Authors | Brad C Astor, Joseph A Eustace, Michael J Klag, Neil R Powe, J Craig Longenecker, Nancy E Fink, Santica M Marcovina, Josef Coresh, CHOICE Study |
Journal | Kidney international
(Kidney Int)
Vol. 61
Issue 3
Pg. 1115-23
(Mar 2002)
ISSN: 0085-2538 [Print] United States |
PMID | 11849466
(Publication Type: Journal Article, Multicenter Study, Research Support, U.S. Gov't, P.H.S.)
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Chemical References |
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Topics |
- Adult
- Aged
- Arteriovenous Shunt, Surgical
(adverse effects)
- Black People
- Blood Vessel Prosthesis
(adverse effects)
- Cohort Studies
- Female
- Humans
- Lipoprotein(a)
(blood)
- Male
- Middle Aged
- Multivariate Analysis
- Prospective Studies
- Renal Dialysis
- Survival Analysis
- Vascular Diseases
(etiology, therapy)
- White People
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