Plasma apolipoprotein A‐IV metabolism in patients with chronic renal disease

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Abstract
The plasma concentration and distribution of apolipoprotein A‐IV were investigated in normo‐triglyceridaemic patients with end‐stage renal disease and compared with those in a sex‐ and age‐matched control group with normal renal function. A three‐fold elevated plasma mean concentration of apolipoprotein A‐IV was found in patients with end‐stage renal disease treated by haemo‐ or peritoneal dialysis (58.5±18.9 mg dl‐1 or 50.5±12.2 mg dl‐1, respectively) compared with the controls (18.3 ± 6.4 mg dl‐1). The plasma distribution of apolipoprotein A‐IV was studied in patients treated by haemodialysis and in controls by gel permeation chromatography. In the haemodialysis group, 40.3% of the apolipoprotein A‐IV was found to be associated with the fraction of high density lipoproteins, whereas the rest (59.7%) was not associated with lipoproteins. This distribution was significantly different from that in the control group (24.8% vs. 75.2%, 0.01 < P<0.05).The elevated plasma concentrations of apolipoprotein A‐IV in the patients are not related to triglyceride levels and therefore are unlikely to result from an impaired catabolism of triglyceride‐rich lipoproteins. The accumulation of apolipoprotein A‐IV in high density lipoproteins from patients with end‐stage renal disease might reflect the impaired reversed cholesterol transport mechanisms which are believed to be a major cause of the high prevalence of atherosclerotic diseases in these patients.