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[Renal dyslipidemia in patients on chronic hemodialysis]
Vedran Kovacić1, Milenka Sain, Valentina Vukman
1Centar za turisticku i domicilnu hemodijalizu, Dom zdravlja Trogir.
Insights
Blood lipid disorders, common in chronic kidney disease patients on dialysis, accelerate atherosclerosis. Early intervention with diet, medications, and dialysis adjustments is crucial for managing renal dyslipidemia.
Area of Science:
- Nephrology
- Cardiology
- Clinical Biochemistry
Context:
- Patients undergoing chronic hemodialysis (PCHD) exhibit distinct blood lipid profiles, including elevated triglycerides and reduced HDL-cholesterol.
- These lipid abnormalities are significant contributors to atherosclerosis progression in PCHD.
- The prevalent Fredrickson phenotype is Type IV, with less frequent Type IIA and IIB, and a notable 9% presenting with isolated Lp(a) elevation.
Purpose:
- To outline the specific characteristics of lipid disorders in PCHD.
- To identify the underlying mechanisms of dyslipidemia in this population.
- To review current and potential treatment strategies for renal dyslipidemia.
Summary:
- Dyslipidemia in PCHD is characterized by hypertriglyceridemia due to impaired VLDL-cholesterol metabolism and altered LDL particle quality, increasing atherogenic risk.
- Effective management requires early and vigorous intervention, encompassing dietary modifications (e.g., omega-3 fatty acids), pharmacotherapy (statins, gemfibrozil, L-carnitine), and oral bicarbonate.
- Advanced treatment modalities include high-flux hemodialysis, low molecular weight heparin, vitamin E-coated dialyzers, and LDL-apheresis for severe cases.
Impact:
- Highlights the critical link between renal dyslipidemia and cardiovascular risk in PCHD.
- Emphasizes the need for proactive and multi-faceted treatment approaches.
- Provides a comprehensive overview of therapeutic options for clinicians managing PCHD.
Abstract:
Disorder of blood lipids plays an important role in atherosclerosis progress in patients ongoing chronic haemodialysis (PCHD). These patients have specific features of blood lipids with increment of triglycerides and decrement of HDL-cholesterol. Phenotype of lipid disorder in PCHD is mostly type IV according to Fredrickson (30%), and IIA and IIB fenotypes are less frequent. About 9% of lipid disorders in PCHD are isolated increase of Lp(a). Main reason of hypertriglyceridemia in PCHD is attenuated metabolism of VLDL-cholesterol because of lipoprotein lipasis inhibition. There are changes in lipoproteins quality, specially changes in LDL particle have atherogenic potential. Renal dyslipidemia treatment must be vigorous in the early stages of renal insufficiency. Treatment can be dietary measures (specially omega-3-fatty acids), statins, gemfibrozil, intravenous L-carnitin and bicarbonate given per os. Haemodialysis modifications such as highflux haemodialysis, low molecular weight heparin, vitamin E coated dialyzers and LDL-apheresis in extreme cases have important role in renal dyslipidemia treatment.