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Improvement of plasma lipoprotein profiles during high-flux dialysis
D S Seres1, G W Strain, S A Hashim
1Department of Medicine, Beth Israel Medical Center, New York, NY.
Insights
Polysulfone (PS) dialysis membranes improve lipid profiles in hemodialysis patients by decreasing triglycerides and increasing high-density lipoprotein. This may reduce cardiovascular disease risk in chronic kidney disease patients.
Area of Science:
- Nephrology
- Cardiovascular Disease
- Lipid Metabolism
Background:
- Patients on maintenance hemodialysis face elevated cardiovascular mortality.
- Lipid abnormalities, including high triglycerides and low HDL, contribute to this risk.
- Chronic renal failure is associated with significant dyslipidemia.
Purpose of the Study:
- To compare the effects of cellulose ester (CE) and polysulfone (PS) high-flux dialysis membranes on lipoprotein profiles.
- To investigate the impact of dialysis membranes on lipid metabolism and lipoprotein lipase (LPL) activity in hemodialysis patients.
Main Methods:
- Lipoprotein profiles (triglycerides, HDL, LDL, total cholesterol) were analyzed in patients undergoing hemodialysis with CE or PS membranes.
- Heparin dosage was consistent between groups.
- Lipoprotein lipase (LPL) activity and serum inhibition were measured.
Main Results:
- CE-dialyzed patients showed no significant changes in lipid profiles.
- PS-dialyzed patients exhibited a significant decrease in triglycerides (P < 0.01) and a significant increase in HDL (P < 0.01).
- PS sera demonstrated significantly greater LPL activity and less LPL inhibition compared to CE sera.
Conclusions:
- Polysulfone membranes may improve lipid profiles in hemodialysis patients, potentially by removing an LPL inhibitor or through improved biocompatibility.
- These improvements in lipoprotein metabolism could lead to reduced atherosclerotic disease morbidity and mortality.
- Cellulose ester membranes do not appear to alter lipid profiles during hemodialysis.
Abstract:
Patients undergoing maintenance hemodialysis therapy have increased mortality due to cardiovascular disease. One possible etiologic factor for this increased mortality is the lipid abnormalities associated with chronic renal failure. These include elevated triglyceride (TG) and decreased high-density lipoprotein (HDL) concentrations. Lipoprotein profiles of patients undergoing chronic hemodialysis with either saponified cellulose ester (CE) (N = 9) or polysulfone (PS) high-flux dialysis membranes (N = 10) were compared. Patients in each group received similar amounts of heparin during the dialysis. CE-dialyzed patients showed no alteration in serum TG, HDL, low-density lipoprotein, or total cholesterol when predialysis and postdialysis values were compared. PS patients, on the other hand, had a significant decrease in TG concentrations (P < 0.01) as well as a significant rise in HDL (P < 0.01). These changes might signify activation of lipoprotein lipase (LPL) during dialysis. LPL activity in PS sera was significantly greater than LPL in CE sera. Moreover, sera from PS patients inhibited LPL much less than did sera from CE patients. These findings suggest that a circulating substance not dialyzable with cellulosic membranes inhibits LPL in uremic subjects and is removed during dialysis with a PS membrane. Alternatively, the greater biocompatibility of PS may produce less LPL inhibitory cytokines during dialysis. The improvement of lipoprotein profiles in patients receiving dialysis with PS membranes may, in the long term, lead to less morbidity and mortality from atherosclerotic disease.