Lipoprotein Metabolism Abnormalities in Patients with Chronic Renal Insufficiency

Abdellah Ali,Mohamed El-Napoli,Phalisteen Sultan,Mohamed Fahmy

doi:10.2478/v10011-010-0040-9

Abstract

Lipoprotein Metabolism Abnormalities in Patients with Chronic Renal InsufficiencyPatients with chronic renal insufficiency (CRI) on hemodialysis develop lipoprotein abnormalities that may contribute to increased risk for atherosclerosis. The objective of this study was to assess the atherogenic risk of chronic renal insufficiency patients and dialysis treated patients (DTP) by measuring total cholesterol (TC), triglycerides (TG), HDL-cholesterol (HDL-C), LDL-cholesterol (LDL-C) and calculating the risk factor ratio: TC/HDL-C and LDL-C/HDL-C. The examined group consisted of 18 chronic renal insufficiency patients and 60 patients on hemodialysis. The results were compared to a control group of 85 voluntary blood donors. Serum lipid parameters were examined by standard methods. All lipid parameters in hemodialysis patients were statistically different as compared to the control group (p<0.05) while chronic renal insufficiency patients showed significant difference only in triglycerides and HDL-cholesterol. Hypertriglyceridemia was present in both examined groups of patients and HDL-cholesterol was lower within both groups. All calculated atherogenic ratios were higher for patients than the control group. Lipid parameters were compared between chronic renal insufficiency and hemodialysis patients, but statistically significant difference was obtained only for HDL-cholesterol (p<0.05). The increased values of triglycerides and lower HDL-cholesterol in chronic renal insufficiency patients contribute to high incidence of cardiovascular disease. Chronic renal insufficiency patients have impaired reverse cholesterol transport from peripheral cells to lipoproteins, decreased levels of HDL-cholesterol, hypertriglyceridemia prevalence of small, dense LDL and increased levels of potentially atherogenic remnant particles.

Highlights

Atherosclerosis and cardiovascular disturbance are common among patients with progressive renal insufficiency and in uremic patients receiving longterm hemodialysis [1, 2]
The principal features of the impaired lipoprotein metabolism include the increase in very-low density lipoprotein (VLDL) and intermediate-density lipoprotein (IDL) fractions, which are mainly due to a defect in the catabo
Patients with CRI, lipid disturbance is characterised by elevated TG and decreased total cholesterol (TC), LDL-C and HDL-C concentrations

Summary

Introduction

Atherosclerosis and cardiovascular disturbance are common among patients with progressive renal insufficiency and in uremic patients receiving longterm hemodialysis [1, 2]. Cardiovascular disease is the most important cause of mortality in end-stage renal disease [3]. Reports suggested that atherosclerosis is accelerated during maintenance hemodialysis for end-stage renal disease. Plasma lipid disturbance have been identified as significant risk factors for cardiovascular disease in this patients. Previous studies have revealed that progressive renal failure is accompanied by abnormalities of lipoprotein transport and that renal insufficiency is predominantly reflected in altered concentrations and composition of individual lipoproteins [4]. The main lipid abnormality is an increase in plasma triglyceride and a decrease in HDL-cholesterol concentrations, with smaller change in the levels of cholesterol rich lipoproteins. The principal features of the impaired lipoprotein metabolism include the increase in very-low density lipoprotein (VLDL) and intermediate-density lipoprotein (IDL) fractions, which are mainly due to a defect in the catabo-

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