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Decreased clearance of low-density lipoprotein in uremic patients under dialysis treatment
S Hörkkö1, K Huttunen, Y A Kesäniemi
1Department of Internal Medicine, University of Oulu, Finland.
Insights
Low-density lipoprotein (LDL) clearance is reduced in uremic patients undergoing hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD). This impaired LDL metabolism may accelerate atherosclerosis in dialysis patients.
Area of Science:
- Nephrology
- Cardiovascular Metabolism
- Lipidology
Background:
- Uremic patients often exhibit dyslipidemia, a known risk factor for cardiovascular disease.
- Altered lipid metabolism, particularly low-density lipoprotein (LDL) clearance, is suspected in patients with chronic kidney disease.
Purpose of the Study:
- To compare LDL clearance rates in patients on hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD) versus healthy controls.
- To investigate the relationship between LDL clearance and plasma lipid levels in uremic patients.
Main Methods:
- Assessed fractional catabolic rate (FCR) for LDL in 11 HD patients, 9 CAPD patients, and 9 control subjects.
- Correlated LDL FCR with plasma total cholesterol, LDL cholesterol, and LDL apolipoprotein B concentrations.
Main Results:
- Overall LDL clearance (FCR) was significantly lower in uremic patients (0.305 pools/day) compared to controls (0.376 pools/day; P=0.01).
- CAPD patients showed markedly reduced LDL clearance (0.268 pools/day) compared to controls (P=0.001).
- LDL clearance negatively correlated with plasma total cholesterol (r=-0.56), LDL cholesterol (r=-0.76), and LDL apolipoprotein B (r=-0.48).
Conclusions:
- Dialysis treatment impairs LDL clearance in uremic patients.
- Reduced LDL catabolism in uremia may contribute to the increased risk of atherosclerosis observed in these individuals.
Abstract:
The clearance of low-density lipoprotein (LDL) was studied in eleven patients on hemodialysis (HD) treatment and nine patients on continuous ambulatory peritoneal dialysis (CAPD) treatment and compared with the clearance of LDL in nine control subjects. The clearance rates for LDL (fractional catabolic rate, FCR) in all the uremic patients (FCR for LDL 0.305 +/- 0.075 pools/day, mean +/- SD) were significantly lower than the clearance of LDL in the control subjects (FCR for LDL 0.376 +/- 0.045 pools/day; P = 0.01). The clearance of LDL in the HD patients (FCR for LDL 0.334 +/- 0.066 pools/day) was only mildly decreased in comparison to the control subjects (P = 0.122), but the clearance of LDL in the CAPD patients was markedly decreased (FCR for LDL 0.268 +/- 0.072 pools/day) in comparison to the control subjects (P = 0.001). The FCR for LDL among all the patients was negatively related to the plasma total cholesterol (r = -0.56, P = 0.01) and LDL cholesterol concentration (r = -0.76, P = 0.0002) and LDL apolipoprotein B concentration (r = -0.48, P = 0.03). In conclusion, the clearance of LDL is decreased in uremic patients on dialysis treatment. This alteration in the LDL metabolism of the uremic patients may contribute to their accelerated atherosclerosis.