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Atherogenic lipids and lipoproteins in hemodialysis patients
A K Cheung1, L L Wu, C Kablitz
1Renal Section, Veterans Affairs Medical Center, Salt Lake City, UT 84148.
Insights
Patients on hemodialysis often have abnormal lipid profiles, including low high-density lipoprotein cholesterol and high levels of certain lipoproteins. These dyslipidemias may increase atherosclerosis risk in this population.
Area of Science:
- Nephrology
- Cardiology
- Clinical Chemistry
Background:
- Dyslipidemia is a potential contributor to atherosclerosis in hemodialysis patients.
- While hypertriglyceridemia is common, hypercholesterolemia is not typically observed in this group.
- Lipid and lipoprotein abnormalities are linked to cardiovascular disease in the general population.
Purpose of the Study:
- To investigate plasma cholesterol and lipoprotein abnormalities in patients with chronic renal failure undergoing hemodialysis.
- To determine if these abnormalities contribute to the high incidence of cardiovascular disease in hemodialysis patients.
Main Methods:
- Studied 24 patients undergoing maintenance hemodialysis.
- Analyzed plasma levels of total cholesterol, high-density lipoprotein cholesterol, apolipoprotein AI, apolipoprotein B, lipoprotein(a), and chylomicron/very low-density lipoprotein remnants.
Main Results:
- Despite low total cholesterol, patients exhibited low high-density lipoprotein cholesterol, low apolipoprotein AI, and high apolipoprotein B.
- Elevated plasma levels of lipoprotein(a) (approx. 40%) and chylomicron/very low-density lipoprotein remnants (approx. 30%) were observed.
- Lipoprotein(a) levels were not predictable from studied variables.
Conclusions:
- Abnormal plasma lipid and lipoprotein profiles are prevalent in hemodialysis patients.
- These atherogenic dyslipidemias likely contribute to the elevated cardiovascular disease risk in this population.
Abstract:
Dyslipidemia may contribute to atherosclerosis in hemodialysis patients. While hypertriglyceridemia is relatively common in this population, hypercholesterolemia is not. Since abnormalities in various plasma cholesterol fractions and lipoproteins have been associated with an increased incidence of cardiovascular disease in the nonuremic population, we examined these abnormalities to determine whether they occur in patients with chronic renal failure. Twenty-four patients on maintenance hemodialysis were studied. We found that, despite relatively low plasma total cholesterol levels, a substantial number of patients had low high-density lipoprotein cholesterol, low apolipoprotein AI, and high apolipoprotein B levels. Furthermore, approximately 40% and 30%, respectively, of the patients had elevated plasma levels of lipoprotein(a) and remnants of chylomicron and very low-density lipoprotein. Lipoprotein(a) levels could not be predicted from any of the variables that were studied. The abnormal plasma levels of these potentially atherogenic lipids and lipoproteins suggest that they may contribute to the high incidence of cardiovascular diseases in the hemodialysis population.