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[Lipid metabolism abnormalities and atherosclerosis in patients on maintenance hemodialysis]
1II Katedry Chorób Wewnetrznych, Collegium Medicum Uniwersytetu, Jagiellońskiego, Krakowie.
Insights
Patients on hemodialysis face high cardiovascular disease risks due to abnormal lipid profiles, including elevated triglycerides and altered lipoproteins, accelerating atherosclerosis.
Area of Science:
- Nephrology
- Cardiology
- Clinical Biochemistry
Context:
- End-stage renal failure patients undergoing maintenance hemodialysis exhibit a high mortality rate.
- Cardiovascular disease is the primary cause of death in this population.
- Lipid abnormalities are recognized as critical risk factors for premature atherosclerosis.
Purpose:
- To review the quantitative and qualitative alterations in lipoprotein composition in hemodialysis patients.
- To explore the potential pathogenesis of these lipoprotein changes.
- To discuss the contribution of these altered lipoproteins to atherogenesis.
Summary:
- Hemodialysis patients present with distinct lipid abnormalities, including elevated serum triglycerides, very-low-density lipoproteins (VLDL), intermediate-density lipoproteins (IDL), remnant particles, and lipoprotein(a) [Lp(a)].
- Concurrently, low-density lipoproteins (LDL) and high-density lipoproteins (HDL) levels decrease, alongside changes in apolipoprotein content.
- These dyslipidemias are strongly implicated in the accelerated development of atherosclerosis.
Impact:
- Understanding these lipid changes is crucial for developing targeted interventions to mitigate cardiovascular risk in hemodialysis patients.
- This review provides insights into the complex interplay between chronic renal failure, lipid metabolism, and cardiovascular pathology.
- Identifying the pathogenic mechanisms can lead to improved therapeutic strategies for preventing atherosclerosis in this vulnerable group.
Abstract:
Cardiovascular disease is the leading cause of death in maintenance hemodialyzed patients with end-stage chronic renal failure. Lipid abnormalities have been identified as significant risk factors for the development of premature atherosclerosis in such patients. These abnormalities include significant elevations of serum triglycerides and triglyceride-rich lipoproteins (VLDL, IDL, remnant particles), Ip(a), decrease in LDL and HDL, accompanied by changes in apolipoprotein content. The article reviews quantitative and qualitative changes in lipoprotein composition and their possible pathogenesis. The role of such changes in atherogenesis is also discussed.