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Decreased clearance of low-density lipoprotein in patients with chronic renal failure
S Hörkkö1, K Huttunen, T Korhonen
1Department of Internal Medicine, University of Oulu, Finland.
Insights
Low-density lipoprotein (LDL) clearance is reduced in uremic patients, even when using their own or control LDL. This impaired LDL metabolism may accelerate atherosclerosis in kidney disease patients.
Area of Science:
- Nephrology
- Cardiovascular Medicine
- Metabolic Research
Background:
- Uremia, a condition of advanced kidney disease, is associated with accelerated atherosclerosis.
- Low-density lipoprotein (LDL) is a key atherogenic particle in plasma.
- Understanding LDL metabolism in uremia is crucial for managing cardiovascular risk.
Purpose of the Study:
- To investigate the clearance rate of LDL in patients with advanced uremia on conservative management.
- To compare LDL clearance between autologous LDL, control LDL, and LDL in healthy subjects.
- To explore the relationship between LDL clearance and markers of kidney function and uremia severity.
Main Methods:
- Studied LDL clearance in 12 uremic patients and control subjects.
- Measured fractional catabolic rate (FCR) of autologous-LDL and control-LDL in patients.
- Correlated FCR with serum urea concentration and glomerular filtration rate.
Main Results:
- Uremic patients showed significantly lower LDL fractional catabolic rates (FCR) compared to controls.
- Autologous-LDL and control-LDL clearance rates were similar within uremic patients.
- Half of the patients exhibited abnormally low LDL clearance, negatively correlating with serum urea levels.
Conclusions:
- Patients with advanced uremia on conservative management frequently have decreased LDL clearance.
- Altered LDL metabolism in uremia may contribute to increased atherosclerosis.
- This finding highlights a potential mechanism for accelerated cardiovascular disease in kidney disease.
Abstract:
The clearance of low-density lipoprotein (LDL) isolated from uremic patients (autologous-LDL) and from a control subject (control-LDL) was studied in 12 uremic patients on conservative management and compared to the LDL clearance in control subjects. The clearances of autologous-LDL and control-LDL were almost the same in the patients. However, the fractional catabolic rate (FCR) of the autologous-LDL (0.307 +/- 0.094 pools/day, mean +/- SD) and the control-LDL (0.289 +/- 0.081 pools/day) were significantly lower (P < 0.05 and P < 0.01, respectively) than the FCR for LDL in the control subjects (0.376 +/- 0.045 pools/day). Moreover, one-half of the patients had an abnormally low LDL clearance rate ranging from 0.146 to 0.282 pools/day. The FCR for the autologous-LDL varied from 0.146 to 0.416 pools/day between the patients and was negatively related (r = -0.68, P = 0.02) to the serum urea concentration (from 11.8 to 39.2 mmol/liter) and tended to correlate positively with the glomerular filtration values (from 9.2 to 48.3 ml/min/1.73 m2; r = 0.57, P = 0.096, non-linear relationship). In conclusion, the clearance of LDL in patients with advanced uremia on conservative management is frequently decreased. This alteration in the metabolism of the most atherogenic particle in plasma may contribute to the accelerated atherosclerosis in uremic patients.