LONGITUDINAL LIPID PROFILES ON CAPD - THEIR RELATIONSHIP TO WEIGHT-GAIN, COMORBIDITY, AND DIALYSIS FACTORS

The dyslipidemia of chronic renal failure may worsen after the commenc ement of continuous ambulatory peritoneal dialysis (CAPD). The purpose of this study was to relate baseline and longitudinal changes in the lipid profile to anthropometrics (weight, mid-arm circumference), aspe cts of treatment (albumin, total protein losses, peritoneal solute tra nsport [dialysate:plasma ratio of creatinine], dialysate caloric load) , total calorie intake (cal/kg), preexisting cardiovascular comorbidit y, and survival. Lipid profiles (triglycerides [TG], total cholesterol [TC], and HDL) were measured, along with the above factors, every 6 m o in an unselected prospective cohort of 124 patients who were not tre ated with lipid-lowering drugs, commencing CAPD between 1990 and 1993, until 1995. On univariate analysis, age, plasma albumin, cardiovascul ar disease, baseline TG, and TC:HDL ratio predicted survival. Simultan eous multiple Cox regression including all of the significant predicto rs demonstrated that either high TG or TC: HDL still predicted death, both in patients with and without clinically overt cardiovascular dise ase. Between 6 and 36 mo of treatment, TC, TG, and TC:HDL were elevate d when compared with the baseline, more so in patients with preexistin g cardiovascular disease (P < 0.05). Throughout this period, weight an d mid-arm circumference correlated positively with TG and negatively w ith HDL. There were positive correlations between TC and albumin level s for 12 mo after commencement of treatment, but otherwise there were no significant or consistent relationships between lipid profiles and total protein losses, dialysate calorie load, or total cal/kg or solut e transport. The worsening dyslipidemia associated with CAPD was not a ssociated with aspects of treatment such as glucose load or protein lo sses. The strongest predictors of worsening lipid profiles were weight gain and preexisting cardiovascular comorbidity.