Uraemic dyslipidaemia revisited: role of high-density lipoprotein

Area of Science:

• Cardiovascular biology
• Lipoprotein metabolism
• Nephrology

Background:

• Chronic kidney disease (CKD) is strongly associated with increased cardiovascular risk.
• Traditionally, high-density lipoprotein (HDL) is considered 'good cholesterol', while low-density lipoprotein (LDL) is 'bad cholesterol'.
• Emerging evidence suggests HDL may lose its protective functions in certain conditions like CKD.

Purpose of the Study:

• To investigate the functional changes of HDL in patients with CKD.
• To determine if HDL in CKD promotes vascular dysfunction and atherosclerosis.
• To evaluate the clinical relevance of HDL cholesterol levels as a marker for vascular health in CKD.

Main Methods:

• Analysis of HDL particles isolated from the blood of CKD patients.
• Assessment of HDL's effects on endothelial cell function and inflammatory activation.
• Review of outcomes from pharmaceutical interventions targeting HDL cholesterol levels.

Main Results:

• HDL from CKD patients exhibits dysfunctional properties.
• This dysfunctional HDL promotes endothelial dysfunction and inflammation.
• These effects contribute to the development of atherosclerotic disease.
• Clinical trials aiming to increase HDL cholesterol have not shown cardiovascular benefits.

Conclusions:

• HDL in CKD patients transforms into a pro-atherosclerotic particle.
• HDL cholesterol levels are not a reliable indicator of HDL's vascular impact in CKD.
• Focus should shift from HDL cholesterol levels to HDL functionality in CKD cardiovascular risk assessment.