Effects of lipid-lowering drugs on intermediate-density lipoprotein in uremic patients

Background. Patients with chronic renal failure often have alterations in l ipoprotein profile including elevated very-low density lipoprotein (VLDL) a nd intermediate density lipoprotein (IDL), and reduced high density lipopro tein (HDL) levels. Among these changes, raised IDL has been shown as an ind ependent risk factor for atherosclerosis in hemodialysis patients. There ar e a limited number of studies reporting pharmacological approaches to IDL r eduction in a uremic population. Methods. We therefore summarize the effects of lipid-lowering drugs on IDL levels in patients with chronic renal failure treated by hemodialysis (HD) or continuous ambulatory peritoneal dialysis (CAPD). Results. First, a nicotinic acid analog niceritrol was given to hemodialysi s patients. The drug increased HDL-cholesterol by 11%, but the reductions i n VLDL-, IDL- and LDL-cholesterol were not significant. Second, CAPD patien ts were treated with a fibric acid derivative clinofibrate, which was excre ted mainly into bile unlike other drugs in this class. The fibrate resulted in a remarkable reduction in VLDL-triglycerides, although it did not reduc e IDL-cholesterol. Finally, an HMG-CoA reductase inhibitor (statin) pravast atin was used in HD and CAPD patients. Pravastatin reduced IDL- and LDL-cho lesterol to the same extent (by 31%). None of these treatments caused serio us adverse effects. Conclusions. We propose that IDL is an important target in the management o f uremic dyslipidemia. To date, statins have been shown to be suitable for this purpose, although it remains to be clarified whether such an intervent ion reduces the risk for atherosclerotic vascular events in the uremic popu lation.