SKELETAL-MUSCLE METABOLISM BEFORE AND AFTER GEMFIBROZIL TREATMENT IN DIALYZED PATIENTS WITH CHRONIC-RENAL-FAILURE

Patients with chronic renal failure appear at greater risk for skeleta l muscle side effects from the fibric acid group of lipid lowering age nts. In order to determine whether sub-clinical defects of skeletal mu scle metabolism can be detected in dyslipidaemic dialysis-dependent pa tients receiving fibrates, we studied nine patients before and after t hree months of gemfibrozil therapy (300-600 mg daily). Aerobic and ana erobic metabolism of the right calf muscle was examined at rest and du ring exercise using P-31 magnetic resonance spectroscopy. Near infra-r ed spectroscopy was used to assess skeletal muscle re-oxygenation foll owing ischaemic exercise of the arm. Following gemfibrozil treatment, plasma triglycerides fell significantly 3.0 +/- 0.5 mM (SEM) to 1.5 +/ - 0.2 mM. Gemfibrozil did not affect the established metabolic defects that exist in the skeletal muscle of the dialysed patient. Skeletal m uscle re-oxygenation was not significantly lower in renal failure and was not altered by gemfibrozil. Gemfibrozil (600 mg daily) significant ly improved the lipid profile of chronic renal failure and was not ass ociated with clinical or bioenergetic impairment of skeletal muscle me tabolism.