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Published on: November 17, 2018
Cholesterol Metabolism in CKD
Allison B Reiss1, Iryna Voloshyna1, Joshua De Leon1
1Department of Medicine and Winthrop Research Institute, Winthrop University Hospital, Mineola, NY.
Insights
Patients with chronic kidney disease (CKD) face high coronary artery disease risk due to inflammation disrupting lipid balance. Dysfunctional high-density lipoprotein and elevated triglycerides contribute to this, impacting vascular health.
Area of Science:
- Nephrology
- Cardiology
- Biochemistry
Background:
- Chronic kidney disease (CKD) significantly increases coronary artery disease (CAD) risk.
- Traditional cardiovascular disease (CVD) risk factors inadequately explain high CVD prevalence in CKD patients.
- Both CKD and CVD are inflammatory conditions impacting lipid metabolism.
Purpose of the Study:
- To review disrupted cholesterol transport in CKD.
- To present evidence on the uremic environment's effect on vascular lipid accumulation.
- To explore preventative and treatment strategies for dyslipidemia in CKD.
Main Methods:
- Review of clinical and preclinical evidence.
- Analysis of lipid metabolism and cholesterol transport in CKD.
- Examination of the impact of inflammation on lipoprotein function.
Main Results:
- CKD-associated dyslipidemia involves elevated triglycerides and decreased, dysfunctional high-density lipoprotein (HDL).
- Dysfunctional HDL loses atheroprotective properties, becoming proinflammatory.
- Impaired triglyceride clearance and altered low-density lipoprotein (LDL) associations complicate risk assessment.
Conclusions:
- Inflammation in CKD disrupts normal lipid balance and cholesterol transport.
- Understanding these mechanisms is crucial for managing cardiovascular risk in CKD.
- Novel therapeutic strategies targeting lipid metabolism are needed for CKD patients.
Abstract:
Patients with chronic kidney disease (CKD) have a substantial risk of developing coronary artery disease. Traditional cardiovascular disease (CVD) risk factors such as hypertension and hyperlipidemia do not adequately explain the high prevalence of CVD in CKD. Both CVD and CKD are inflammatory states and inflammation adversely affects lipid balance. Dyslipidemia in CKD is characterized by elevated triglyceride levels and high-density lipoprotein levels that are both decreased and dysfunctional. This dysfunctional high-density lipoprotein becomes proinflammatory and loses its atheroprotective ability to promote cholesterol efflux from cells, including lipid-overloaded macrophages in the arterial wall. Elevated triglyceride levels result primarily from defective clearance. The weak association between low-density lipoprotein cholesterol level and coronary risk in CKD has led to controversy over the usefulness of statin therapy. This review examines disrupted cholesterol transport in CKD, presenting both clinical and preclinical evidence of the effect of the uremic environment on vascular lipid accumulation. Preventative and treatment strategies are explored.
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