Dyslipidemia and dietary modification in Chilean renal pediatric transplantation

Abstract

RENAL transplantation has significantly improved patient prognosis in chronic renal failure. However, increasing attention is drawn to the high incidence of cardiovascular morbidity and mortality in renal transplant recipients. Persistent hypercholesterolemia of adults posttransplant is a risk factor for accelerated atherosclerosis and a 10% incidence of ischemic heart disease at 3-year follow up was observed. In both the European transplant and in the USRDS registry, cardiovascular disease is the most common cause of death posttransplantation. The reason may be the accumulation of risk factors such as hypertension and dyslipidemia. Hypetriglyceridemia and hypercholesterolemia posttransplant have been described widely in the adult literature and sporadically in pediatric transplant studies. Since the initiation of NAPRTCS, several changes in the practice patterns for donors have been observed. These changes have improved 1-year graft survival of transplant, so that most recent data show cadaveric donor graft survival in 1996 to be as good as living donor graft survival was in 1987. The survival for recipients of living donor organs has increased from 88% in 1987 to 93% in 1996. The estimated half-life of the allograft is approximately 10 years; therefore, it is necessary to prevent lipid alterations at an early age in renal pediatric transplant recipients to ensure a reasonable chance of long-term survival in adult life through dietetic therapy or hypolipemic agents. Contributing factors to posttransplant dyslipidemia include renal dysfunction, proteinuria, pretransplant dialysis, immunosuppressive therapy with corticosteroids, cyclosporine, beta-adrenergic antagonist, or combinations of these factors. The impact of dyslipidemia on long-term graft and patient survival in renal transplant recipients is generally accepted. The influence of immunosuppressive drugs is clearly implicated in maintaining hypetriglyceridemia and in the development of hypercholesterolemia posttransplant. Dietary intervention remains as a cornerstone in the prevention and treatment of the hyperlipidemia. The American Heart Association (AHA) and National Cholesterol Education Program (NCEP) have provided guidelines for the treatment of hyperlipidemic patients, including the Step II Diet. When this approach fails, pharmacologic therapy should be considered. In adult patients, diet caused modest reductions in total cholesterol and LDL-C; HMGCoA reductase inhibitors caused the greatest and most consistent reductions in cholesterol and LDL-C. The purpose of this study was to characterize the Chilean renal transplant population in respect to lipid profile. We tested whether an easily reproducible diet such as the AHA Step II Diet would be effective in lowering cholesterol levels in hyperlipidemic renal transplant recipients.