LOW-DENSITY-LIPOPROTEIN SUBFRACTION PROFILES IN DIALYSIS PATIENTS

Uraemic dyslipidaemia is a major risk factor for cardiovascular diseas e in end-stage renal failure patients. In patients without renal failu re, high levels and qualitative abnormalities of low-density lipoprote in (LDL) are known to be atherogenic. Recently, LDL subfraction analys is has associated premature coronary artery disease with a high preval ence of small, dense LDL particles characterizing the LDL subclass phe notype B. We therefore examined the lipid profiles, LDL subfraction di stribution and phenotypes in our population of haemodialysis (HD; n = 30) and peritoneal dialysis patients (PD; n = 17), and compared them t o 40 asymptomatic, non-uraemic volunteers. Dialysis patients had signi ficantly higher triglyceride and VLDL cholesterol concentrations and l ower HDL cholesterol and smaller LDL peak particle diameters. PD patie nts had significantly higher total cholesterol, glycated haemoglobin a nd fasting blood glucose levels with smaller LDL peak particle diamete rs (24.4 [0.1] vs 24.8 [0.1 nm] than HD. Both groups showed significan t negative correlations between plasma triglyceride and LDL peak parti cle diameter, and positive correlations between HDL cholesterol and LD L peak particle diameter. All the PD patients expressed the B phenotyp e (LDL peak diameter less than or equal to 25.5 nm) compared to 73% of HD patients. This study demonstrates that HD and especially PD patien ts have atherogenic lipid profiles which are associated with a predomi nance of small dense LDL particles and the highly atherogenic LDL subc lass phenotype B.