The effect of diet on hypercholesterolemia in renal transplant recipients

Abstract

• ■ Objective: To compare the effects of cholesterol-lowering diet intervention on lipid levels in hypercholesterolemic renal transplant recipients and hypercholesterolemic normal subjects. • ■ Design: Controlled clinical trial. • ■ Setting: Clinical research center. • ■ Patients: Thirteen hypercholesterolemic subjects, 6 with renal transplants and 7 control subjects. • ■ Intervention: Four weeks of the average American diet, followed by 4 weeks of the National Cholesterol Education Program's Step-Two Diet. • ■ Main Outcome Measures: Three lipid profiles measured on each diet. • ■ Results: The control subjects experienced a significant average decrease in total cholesterol of 0.91 mmol/L (35 mg/dL) or 13.1% (p < .001). Although markedly lower, the transplantation subjects did experience a decrease in total cholesterol of 0.35 mmol/L (13.6 mg/dL) or 5.4%, which was significant (p < .05). Among the transplant subjects, response to the lipid-lowering diet was positively correlated with creatinine clearance and negatively correlated with blood cyclosporine levels. High-density lipoprotein cholesterol levels were higher in the transplant subjects than in the control subjects, suggesting a less atherogenic lipid profile in the transplant subjects. • ■ Conclusions: Response to lipid-lowering diet intervention in renal transplant recipients may be less than in the general population, possibly relating to decreased creatinine clearance and/or cyclosporine therapy. More aggressive diet and medication interventions are needed to control hypercholesterolemia in the renal transplant population.