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Plasma cholesterol metabolism in end-stage renal disease. Difference between treatment by hemodialysis or peritoneal

H Dieplinger, P Y Schoenfeld, C J Fielding

    The Journal of Clinical Investigation
    |April 1, 1986
    PubMed

    Insights

    Hemodialysis patients show altered cholesterol metabolism, with reversed free cholesterol transport and reduced esterification. Continuous ambulatory peritoneal dialysis patients, however, maintain normal cholesterol metabolism and lipoprotein profiles.

    Area of Science:

    • Biochemistry
    • Nephrology
    • Lipid Metabolism

    Background:

    • End-stage renal disease (ESRD) significantly impacts systemic metabolic processes.
    • Cholesterol metabolism is crucial for cellular function and cardiovascular health.
    • Dialysis modalities may differentially affect lipid profiles in ESRD patients.

    Purpose of the Study:

    • To investigate plasma cholesterol metabolism in ESRD patients undergoing hemodialysis (HD) versus continuous ambulatory peritoneal dialysis (CAPD).
    • To compare lipid metabolism and lipoprotein composition between dialysis patients and healthy controls.

    Main Methods:

    • Analysis of plasma cholesterol transport in cultured fibroblasts.
    • Measurement of cholesterol esterification and transfer rates to lipoproteins (LDL, VLDL).
    • Biochemical analysis of lipoprotein composition (free cholesterol, triglycerides, cholesterol esters).

    Main Results:

    • Hemodialysis patients exhibited reversed free cholesterol transport from plasma to fibroblasts.
    • Reduced plasma cholesterol esterification and suppressed cholesterol ester transfer to LDL and VLDL were observed in the HD group.
    • LDL and VLDL in HD patients showed increased free cholesterol, decreased cholesterol esters, and doubled triglyceride content.
    • CAPD patients demonstrated cholesterol metabolic rates and lipoprotein compositions comparable to controls.

    Conclusions:

    • Hemodialysis significantly disrupts normal plasma cholesterol metabolism and alters lipoprotein composition in ESRD patients.
    • Continuous ambulatory peritoneal dialysis appears to preserve normal cholesterol metabolism and lipoprotein profiles in ESRD.
    • These findings highlight the differential impact of dialysis modalities on lipid metabolism in kidney disease.

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