High-density lipoprotein: structural and functional changes under uremic conditions and the therapeutic consequences

Area of Science:

• Cardiovascular Medicine
• Nephrology
• Biochemistry

Background:

• High-density lipoprotein (HDL) is a key target for cardiovascular disease (CVD) therapy.
• Increasing HDL plasma levels has shown variable success in reducing cardiovascular risk.
• HDL particle composition is complex and susceptible to modification in disease states.

Purpose of the Study:

• To review dyslipidemia in chronic kidney disease (CKD) patients.
• To examine the impact of lipid-modulating therapies on HDL in CKD.
• To explore HDL structural modifications and their link to dysfunction in CKD.

Main Methods:

• Literature review of studies on HDL, dyslipidemia, and CKD.
• Analysis of factors affecting HDL composition in CKD (uremic toxins, oxidative stress, inflammation).
• Examination of lipid-modulating therapies and their effects on HDL function.

Main Results:

• CKD is associated with altered HDL composition and reduced protective function.
• Uremic toxins, oxidative stress, and inflammation contribute to HDL dysfunction in CKD.
• Therapeutic strategies must consider both HDL quantity and functional quality.

Conclusions:

• Dyslipidemia in CKD involves significant HDL modifications impacting its protective role.
• Understanding HDL structural changes is vital for effective cardiovascular risk management in CKD.
• Future therapies should aim to restore HDL functionality, not just increase levels.