STRATEGIES IN RENAL-FAILURE AND THE IMPACT OF LIPIDS

The main points to note in terms of strategies in renal failure and th e impact of lipids are: 1) Timing and typing of dyslipidemia; 2) Occur rence of dyslipidemia in the course of strategies (conservative, dialy sis and transplantation); 3) How the strategies can handle the impact of lipids. Analysis of point 1 confirms what a complex profile uremic dyslipidemia presents, involving the type, class, composition and enzy me systems involved in lipid metabolism. In conservative and dialysis, type IV (triglycerides) predominates; in transplantation, type II (ch olesterol). Examination of point 2 shows the non obligatory relationsh ip between dyslipidemia and the various strategies of treatment. Lipid abnormalities type IV or II, occur in 50-60% of patients. Uremic fact ors for dyslipidemia include: 1) enhanced hepatic stimulation or alter ed removal in conservative strategies; 2) the same causes plus ''speci fic'' promotors in dialysis (dialysis fluid, plasticizer leaching; bio incompatibility, etc.); 3) steroid therapy and other ''accessories'' i n transplantation. A genetic predisposition is very likely present in all patients. Point 3, finally, analyzes the various ''supplements'' t hat each strategy requires to cope with the lipid impact. Generic rule s (ranging from doing nothing, to diet, drugs, etc.) are of value in a ll strategies when dyslipidemia occurs. More specific rules include: a ) Conservative strategies: appropriate dietetic optimization and modul ation (protein-lipid-carbohydrate ratio in terms of calories); b) Dial ysis: timing treatment and improving biocompatibility; c) Transplantat ion: reducing steroids as much as possible.