Lipid metabolism in renal failure

Many patients with renal failure show abnormalities of lipid metabolism. Hypertriglyceridemia and low levels of high density lipoprotein (HDL) cholesterol are frequent abnormalities in uremic patients. The hypertriglyceridemia and low HDL cholesterol are thought to result from decreased lipoprotein lipase activity. The decreased levels of hepatic lipase observed in renal failure may account for the presence of intermediate density lipoproteins (IDL) and the high HDL2 subfraction. The risk factor for coronary artery disease expressed as the ratio of total cholesterol to HDL cholesterol is elevated in renal failure patients, especially in those with hypertriglyceridemia. Treatment of renal patients with gemfibrozil partially reverses many of the lipid abnormalities including the low HDL cholesterol. However, only the HDL3 subfraction increased while HDL2 remained unchanged.