Relationship between Icodextrin use and decreased level of small low-density lipoprotein cholesterol fractioned by high-performance gel permeation chromatography

Eiichiro Kanda,Asami Iwamoto,Mitsuyo Okazaki,Sei Sasaki,Masayuki Yoshida,Masumi Ai,Yoshitaka Maeda

doi:10.1186/1471-2369-14-234

Abstract

BackgroundBecause of the absorption of glucose in peritoneal dialysis (PD) solution, PD patients show an atherogenic lipid profile, which is predictive of poor survival in PD patients. Lipoprotein subclasses consist of a continuous spectrum of particles of different sizes and densities (fraction). In this study, we investigated the lipoprotein fractions in PD patients with controlled serum low-density lipoprotein (LDL) cholesterol level, and evaluated the effects of icodextrin on lipid metabolism.MethodsForty-nine PD patients were enrolled in this cross-sectional study in Japan. The proportions of cholesterol levels to total cholesterol level (cholesterol proportion) in 20 lipoprotein fractions were measured using an improved method of high-performance gel permeation chromatography (HPGPC).ResultsTwenty-six patients used icodextrin. Although no significant differences in cholesterol levels in LDL and high-density lipoprotein (HDL) were observed between the patients using icodextrin (icodextrin group) and control groups, HPGPC showed that the icodextrin group had significantly lower cholesterol proportions in the small LDL (t-test, p=0.053) and very small LDL (p=0.019), and significantly higher cholesterol proportions in the very large HDL and large HDL than the control group (p=0.037; p=0.066, respectively). Multivariate analysis adjusted for patient characteristics and statin use showed that icodextrin use was negatively associated with the cholesterol proportions in the small LDL (p=0.037) and very small LDL (p=0.026), and positively with those in the very large HDL (p=0.040), large HDL (p=0.047), and medium HDL (p=0.009).ConclusionsHPGPC showed the relationship between icodextrin use and the cholesterol proportions in lipoprotein fractions in PD patients. These results suggest that icodextrin may improve atherogenic lipid profiles in a manner different from statin.

Highlights

Because of the absorption of glucose in peritoneal dialysis (PD) solution, PD patients show an atherogenic lipid profile, which is predictive of poor survival in PD patients
A high low-density lipoprotein (LDL)-C level was treated in accordance with the evidence-based practice guideline 2009 for the treatment of chronic kidney disease established by the Japanese Society of Nephrology and clinical guidelines for the evaluation and treatment of cardiovascular complications in hemodialysis patients established by the Japanese Society for Dialysis Therapy [17,18]
The icodextrin and control groups were matached for gender, age, body mass index (BMI), serum calcium level, serum albumin level, C-reactive protein (CRP) level, and PD vintage

Summary

Introduction

Because of the absorption of glucose in peritoneal dialysis (PD) solution, PD patients show an atherogenic lipid profile, which is predictive of poor survival in PD patients. Lipoprotein subclasses consist of a continuous spectrum of particles of different sizes and densities (fraction). We investigated the lipoprotein fractions in PD patients with controlled serum low-density lipoprotein (LDL) cholesterol level, and evaluated the effects of icodextrin on lipid metabolism. Cardiovascular disease (CVD) is one of the leading causes of death in patients on peritoneal dialysis (PD) [1,2]. Lipoprotein subfractions consist of a continuous spectrum of particles of different sizes and densities. Small dense low-density lipoproteins (LDLs) and highdensity lipoproteins (HDLs) are related to CVD events [4,5]. PD patients tend to show high levels of total cholesterol, LDL cholesterol (LDL-C), triglyceride (TG), and small dense LDL-C with a low level of HDL cholesterol (HDL-C) [6]

Objectives

Methods

Results

Discussion

Conclusion