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Fall of cholesterol with time on dialysis: impact on atherogenicity
1Long Island College Hospital, Division of Nephrology, Brooklyn, New York 11201.
Insights
Patients with chronic renal failure often face cardiovascular issues. This study found that longer dialysis treatment correlates with lower total cholesterol and improved lipid profiles in hemodialysis patients.
Area of Science:
- Nephrology
- Cardiovascular Medicine
- Clinical Chemistry
Background:
- Chronic renal failure (CRF) patients have high cardiovascular mortality.
- Lipid abnormalities are implicated in CRF-related cardiovascular complications.
- Dialysis duration may influence lipid levels in CRF patients.
Purpose of the Study:
- To investigate lipid disturbances in patients undergoing chronic dialysis.
- To examine the relationship between dialysis duration and lipid profiles.
- To compare lipid profiles between hemodialysis and continuous ambulatory peritoneal dialysis (CAPD) patients.
Main Methods:
- Multivariate analysis of lipid profiles in 53 CAPD and 126 hemodialysis patients.
- Longitudinal assessment of lipid values over 9-10 months in subsets of patients.
- Analysis of covariance and paired t-tests to assess correlations and changes.
Main Results:
- Inverse correlation found between months on dialysis and total cholesterol (TC), HDL cholesterol, and apolipoprotein A-I levels.
- TC levels were higher in women, CAPD patients, and correlated with age and albumin.
- HDL cholesterol was higher in Black patients; TC/HDL ratio and apolipoprotein B were higher in White patients.
- Hemodialysis patients showed a significant decrease in TC over time, more pronounced with shorter dialysis duration.
Conclusions:
- Dialysis duration is a significant factor influencing lipid profiles in CRF patients.
- Hemodialysis is associated with a decrease in TC over time, suggesting a potential benefit of longer treatment duration on lipid metabolism.
- Differences in lipid profiles exist based on race and dialysis modality, impacting cardiovascular risk assessment.
Abstract:
The majority of patients treated for chronic renal failure die from cardiovascular complications. Lipid abnormalities in this group are thought to contribute to this high mortality. The authors have shown that hemodialysis patients with longer months on dialysis tend to have lower total cholesterol (TC) levels. This study extends data to examine lipid disturbances in 53 continuous ambulatory peritoneal dialysis (CAPD) and 126 hemodialysis patients using multivariate analysis. Longitudinal values after 9-10 months were measured in 16 CAPD patients and 52 hemodialysis patients. Analysis of covariance for all patients demonstrated an inverse correlation of TC (p = 0.003), high-density lipoprotein (HDL) cholesterol (p = 0.01), and apolipoprotein A-I levels (p less than 0.02) with months on dialysis. In addition, the TC level was higher in women (p less than 0.001) and CAPD patients (p less than 0.001), and correlated with age (p = 0.02) and albumin (p less than 0.001). HDL cholesterol was higher in blacks (p less than 0.001) but was not affected by gender, dialysis modality, age, or albumin. Diabetic status, serum parathyroid hormone, and blood pressure were not significant variables for TC or HDL-C. The atherogenic risk indicators, TC/HDL cholesterol (p less than 0.001) and apolipoprotein B (p less than 0.02) were higher in whites than in blacks. Longitudinal study revealed lower TC levels in individual hemodialysis patients (p less than 10(-6) by paired t-test), the fall being greater for patients with fewer total months on dialysis (p less than 0.04, by analysis of covariance). CAPD patients had no change in TC by paired t-test.(ABSTRACT TRUNCATED AT 250 WORDS)