Abstract
Dyslipidemia is common among patients on hemodialysis, but its etiology is not fully understood. Although changes in cholesterol homeostasis and fatty acid metabolism play an important role during dialysis, the interaction of these metabolic pathways has yet to be studied in sufficient detail. In this study, we enrolled 26 patients on maintenance hemodialysis treatment (high-volume hemodiafiltration, HV HDF) without statin therapy (17 men/9 women) and an age/gender-matched group of 26 individuals without signs of nephropathy. The HV-HDF group exhibited more frequent signs of cardiovascular disease, disturbed saccharide metabolism, and altered lipoprotein profiles, manifesting in lower HDL-C, and raised concentrations of IDL-C and apoB-48 (all p < 0.01). HV-HDF patients had higher levels of campesterol (p < 0.01) and β-sitosterol (p = 0.06), both surrogate markers of cholesterol absorption and unchanged lathosterol concentrations. Fatty acid (FA) profiles were changed mostly in cholesteryl esters, with a higher content of saturated and n-3 polyunsaturated fatty acids (PUFA) in the HV-HDF group. However, n-6 PUFA in cholesteryl esters were less abundant (p < 0.001) in the HV-HDF group. Hemodialysis during end-stage kidney disease induces changes associated with higher absorption of cholesterol and disturbed lipoprotein metabolism. Changes in fatty acid metabolism reflect the combined effect of renal insufficiency and its comorbidities, mostly insulin resistance.
Highlights
Lowering LDL cholesterol concentration is widely accepted as an effective tool for reducing cardiovascular mortality
There were no differences between the HV-HDF group and non-dialysed individuals without signs of chronic kidney disease (CKD) with regard to the conventional risk factors for atherosclerotic cardiovascular disease (ASCVD) (age, sex ratio, presence of hypertension, DM, dyslipidaemia)
Most changes in fatty acid profiles were observed in cholesteryl esters, the lipid class formed in plasma during the metabolism of lipoprotein particles that is known to be impaired in hemodialyzed patients [15]
Summary
Lowering LDL cholesterol concentration is widely accepted as an effective tool for reducing cardiovascular mortality. Statin treatment is not completely successful in mitigating cardiovascular complications among patients on maintenance dialysis therapy. Concentrations of lathosterol (a surrogate marker of cholesterol biosynthesis) are reported to be lowered or unchanged, with concentrations of phytosterols (a surrogate marker of cholesterol absorption) usually elevated or unchanged. Phytosterols interfere with cholesterol absorption in the gut, being able to lower plasma cholesterol. This effect is useful for the reduction of LDL cholesterol levels in dyslipidemic patients as a part of nonpharmacological therapy and as a supplement to statin/ezetimibe treatment
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