LIPOPROTEIN ABNORMALITIES IN CHRONIC-RENAL-FAILURE AND DIALYSIS PATIENTS

Lipoprotein abnormalities are common in patients with chronic renal fa ilure (CRF) on either dialysis or conservative therapy. In order to in vestigate the changes in lipid and apolipoprotein pattern from early C RF to dialysis treatment, plasma lipids with apoproteins AI, B, E, CII , CIII, CII/CIII ratio, E/CIII ratio, parathyroid hormone (PTH) and in sulin levels were examined in 72 patients with different degrees of CR F and 31 patients on hemodialysis (HD), and compared the values of 28 controls. A significant decrease in the Apo CII/CIII ratio was the ear liest lipoprotein abnormality to occur in CRF. Hypertriglyceridemia (H TG) with reduced high-density lipoprotein cholesterol levels, increase d Apo CIII and decreased Apo E/Apo CIII ratio only occurred in more ad vanced renal failure (creatinine clearance <31 ml/min). HD patients sh owed a general worsening of the lipoprotein profile with elevated Apo E levels and indirect evidence of remnant accumulation. While PTH did not have any significant influence on lipoprotein pattern, increased i nsulin levels during HD might partly account for the HTG of these pati ents. Our results point to elevated Apo CIII, reduced Apo CII/Apo CIII and Apo El Apo CIII ratios as typical features of uremic hyperlipidem ia and show that a defective triglyceride removal is the major pathoge netic mechanism of uremic HTG. HD treatment seems generally to worsen the lipid and apolipoprotein pattern observed in the predialytic stage of CRF.