ATHEROGENIC LIPOPROTEIN CHANGES IN THE ABSENCE OF HYPERLIPIDEMIA IN PATIENTS WITH CHRONIC-RENAL-FAILURE TREATED BY HEMODIALYSIS

We compared plasma lipid and lipoprotein parameters between 210 chroni c renal failure patients treated by hemodialysis and 223 age- and sex- matched healthy control subjects to examine whether atherogenic lipopr otein changes were present in hemodialysis patients in the absence of hyperlipidemia. The hemodialysis group showed higher levels of plasma triglycerides, very low density lipoprotein (VLDL) cholesterol, and in termediate density lipoprotein (IDL) cholesterol and a lower level of high density lipoprotein (HDL) cholesterol. Low density lipoprotein (L DL) cholesterol of the hemodialysis group was not elevated but their L DL was significantly more triglyceride-enriched than that of controls. Subjects were then divided into five categories according to their pl asma triglyceride levels at an interval of 50 mg/dl, and comparison wa s made between the two groups in the same range of plasma triglyceride s. Hemodialysis patients again showed higher levels of VLDL- and IDL-c holesterol, and lower levels of HDL-cholesterol than the control group even in the plasma triglycerides-matched comparisons. Similarly, high er VLDL- and IDL-cholesterol levels in hemodialysis patients were sign ificant in plasma total cholesterol-matched subgroup comparisons. Mult iple regression analysis indicated that the relationship between plasm a lipid concentrations and individual lipoprotein levels were substant ially altered in uremic state. The 95th percentile level of IDL-choles terol in the nonuremic controls was 15 mg/dl, and 45% of hemodialysis patients exceeded this level. Decreased HDL-cholesterol levels less th an or equal to 35 mg/dl were seen in 6% of the control and 38% of the hemodialysis group. Elevated IDL-cholesterol and decreased HDL-cholest erol were persistently found in hemodialysis patients with normal lipi d levels. It is concluded that hemodialysis patients exhibited more at herogenic lipoprotein profile than nonuremic subjects with comparable levels of plasma triglycerides and total cholesterol. Especially, incr eased IDL- and decreased HDL-cholesterol levels in hemodialysis patien ts persisted even at very low levels of plasma lipids. Since elevated IDL and decreased HDL-cholesterol are implicated in the progression of atherosclerosis, these findings are of clinical importance in the dia gnosis of lipoprotein disorder in chronic renal failure. (C) 1997 Else vier Science Ireland Ltd.