HYPERTRIGLYCERIDEMIA AND LOWERED APOLIPOPROTEIN C-II C-III RATIO IN UREMIA - EFFECT OF A FIBRIC ACID, CLINOFIBRATE/

We examined the effects of a fibric acid, clinofibrate, on lipoprotein metabolism in 12 hyperlipidemic patients with uremia treated on conti nuous ambulatory peritoneal dialysis during a 24 week treatment. Daily dose of clinofibrate was 200 mg for the initial four weeks, 400 mg fo r the second four weeks, and 600 mg for the subsequent 16 weeks. Serum and very-low density lipoprotein (VLDL) triglyceride were decreased b y 36% and 48%, respectively. Neither total cholesterol nor apolipoprot ein B changed significantly, whereas cholesterol was decreased in VLDL and increased in low (LDL) and high density lipoprotein (HDL) fractio ns. Post-heparin plasma lipoprotein lipase (LPL) before treatment was not lower than the normal value, and we found no change in LPL activit y following clinofibrate. Hepatic triglyceride lipase also did not cha nge. Apolipoprotein ( apo) C-II/C-III ratio was low as compared to the normal value before treatment, and the ratio was increased by 38% aft er the treatment. Decrease in VLDL triglyceride was associated with in crease in apo C-II/C-III ratio in all the cases. Abnormal enrichment w ith triglyceride of LDL and HDL fractions was improved by clinofibrate . Although one patient had a transient and asymptomatic elevation of s erum creatine phosphokinase, no patient had muscle pain. There was no accumulation of the drug in the 24 week trial. These results suggest t hat clinofibrate is an effective and safe approach to the management o f dyslipidemia in CAPD patients.