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Ann Thorac Surg 2005;80:382-383
© 2005 The Society of Thoracic Surgeons

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Correspondence

Apolipoprotein E Polymorphism and the Risk of Acute Nephropathy After Cardiac Surgery

Department of Internal Medicine, School of Medicine, University of Ioannina, Ioannina, Greece 45110

(Email: egepi{at}cc.uoi.gr).

To the Editor:

We have read with great interest the article by MacKensen and colleagues [1] on the possible interaction of apolipoprotein E (ApoE) polymorphism with aortic arteriosclerosis in predicting acute nephropathy after cardiac surgery. The authors showed that compared with ApoE4 patients, non-ApoE4 patients had a larger increase in peak postoperative creatinine concentration at equivalent levels of ascending aortic atheroma burden [1]. These data, as well as those reported earlier by the same group [2] suggest that ApoE4 possibly exhibits a nephroprotective effect. In this context we would like to comment on the methodology and results of this work.

First, the authors do not report the laboratory method used for creatinine determination. Second, postoperative creatinine clearance was estimated from the maximum postoperative creatinine concentration, whereas it is well known that such estimation is inaccurate in the case of unsteady creatinine levels [3]. Furthermore, the authors state that their results are consistent with the ApoE allele specific pattern described in chronic renal diseases. However, some studies have related ApoE4 allele with the progression of renal disease in diabetic patients [4] and in renal transplant recipients [5].

Overall the results presented by MacKensen and colleagues [1] are in agreement with our recently published data. Specifically, ApoE4 allele was associated with lower serum creatinine concentration and higher predicted glomerular filtration rate compared with ApoE2 and ApoE3 alleles in a population of healthy individuals, although the difference between ApoE4 and ApoE3 alleles did not reach statistical significance [6]. Moreover, we have observed a significantly lower prevalence of the ApoE4 allele in end-stage renal disease patients compared with healthy controls [7]. Consequently, all these data underlie the need to further study the role of ApoE polymorphism on the pathogenesis of renal diseases [8].

	References

Top References

 

1. MacKensenG B, Swaminathan M, Ti LK, et al. Preliminary report on the interaction of apolipoprotein E polymorphism with aortic atherosclerosis and acute nephropathy after CABG Ann Thorac Surg 2004;78:520-526.[Abstract/Free Full Text]
2. Chew STH, Newman MF, White WD, et al. Preliminary report on the association of apolipoprotein E polymorphisms with postoperative peak serum creatinine concentrations in cardiac surgical patients Anesthesiology 2000;93:325-331.[Medline]
3. Levey AS, Bosch JP, Lewis JB, et al. A more accurate method to estimate glomerular filtration rate from serum creatininea new prediction equation. Ann Intern Med 1999;130:461-470.[Abstract/Free Full Text]
4. Lehtinen S, Rantalaiho V, Wirta O, et al. Apolipoprotein E gene polymorphism, hypercholesterolemia and glomerular filtration rate in type 2 diabetic subjectsa 9-year follow-up study. J Biomed Sci 2003;10:260-265.[Medline]
5. Roussos L, Floren CH, Carlson J, Svensson PJ, Wallmark A, Ekberg H. Increased prevalence of apolipoprotein E3/E4 genotype among Swedish renal transplant recipients Nephron 1999;83:25-30.[Medline]
6. Liberopoulos EN, Miltiadous GA, Cariolou M, Kalaitzidis R, Siamopoulos KC, Elisaf MS. Influence of apolipoprotein E polymorphisms on serum creatinine levels and predicted glomerular filtration rate in healthy subjects Nephrol Dial Transplant 2004;19:2006-2012.[Abstract/Free Full Text]
7. Liberopoulos EN, Miltiadous GA, Cariolou M, Tselepis AD, Siamopoulos KC, Elisaf MS. The influence of apolipoprotein E concentration and polymorphism on serum lipid parameters in hemodialysis patients Am J Kidney Dis 2004;44:300-308.[Medline]
8. Liberopoulos E, Siamopoulos K, Elisaf M. Apolipoprotein E and renal disease Am J Kidney Dis 2004;43:223-233.[Medline]

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