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The uremic dyslipidemia: a cross-sectional and longitudinal study
M M Avram1, P Goldwasser, D E Burrell
1Division of Nephrology, Avram Center for Kidney Diseases, Long Island College Hospital, Brooklyn, NY 11201.
Summary
Patients undergoing continuous ambulatory peritoneal dialysis (CAPD) have more atherogenic lipid profiles than those on hemodialysis (HD). Nutritional status influences these lipid disturbances and cardiovascular risk in dialysis patients.
Area of Science:
- Nephrology
- Cardiovascular Medicine
- Clinical Biochemistry
Background:
- Patients on maintenance hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD) exhibit lipid and apoprotein disturbances linked to high cardiovascular mortality.
- Previous studies suggest lipid levels are inversely related to dialysis duration, but the reasons (patient attrition vs. lipid decrease) remain unclear.
- The impact of dialysis modality on uremic lipoprotein disturbances, adjusted for confounding factors, requires further investigation.
Purpose of the Study:
- To investigate cross-sectional and longitudinal changes in lipids, apoproteins, and atherogenic risk ratios in HD and CAPD patients.
- To determine the influence of dialysis modality, clinical factors, and nutritional status on lipoprotein profiles.
- To examine the relationship between lipid profiles and mortality in dialysis patients.
Main Methods:
- Cross-sectional and longitudinal study of 196 HD and 77 CAPD patients enrolled in annual cohorts from 1987-1990, monitored until 1991.
- Measurement of total cholesterol (TC), HDL-C, apo A-I, and apo B at enrollment and annually in survivors.
- Multivariate analysis to assess relationships between lipids, apoproteins, risk ratios, clinical factors (race, gender, diabetes, PTH), nutritional status (albumin), and mortality.
Main Results:
- CAPD patients showed significantly higher TC, apo A-I, apo B, and lower apo A-I/apo B ratio compared to HD patients.
- Serum albumin correlated with lipid levels and atherogenic ratios; normal albumin was linked to higher TC/HDL-C in CAPD patients.
- Patients who died had lower TC and apo B, and higher apo A-I/apo B ratio compared to survivors throughout their course.
Conclusions:
- Continuous ambulatory peritoneal dialysis (CAPD) patients exhibit more atherogenic lipoprotein profiles than hemodialysis (HD) patients.
- Improved nutritional status (higher serum albumin) is associated with hyperlipidemia and worsened atherogenic risk ratios, particularly in CAPD.
- Lipid profiles, while stable longitudinally, showed differences between HD and CAPD patients and were associated with mortality risk.