Dyslipidemia and renal disease: pathogenesis and clinical consequences

Patients with chronic renal disease suffer from a secondary form of complex dyslipidemia. The most important abnormalities are an increase in serum tr iglyceride levels (elevated VLDL-remnants/DL), small LDL particles and a lo w HDL cholesterol level, The highly atherogenic LDL subclass, namely LDL-6 or small dense LDL, accumulates preferentially in hypertriglyceridemic diab etic patients with nephropathy or on hemodialysis treatment. All these lipo protein particles contain apolipoprotein B, thus the complex disorder can b e summarized as an elevation of triglyceride-rich apolipoprotein B-containi ng complex lipoprotein particles. Growing evidence suggests that all of the components of this type of dyslipidemia are independently atherogenic. The se particles, specifically the apolipoprotein B moiety, are predominantly p rone to modification such as oxidation and glycosilation, which contributes to impaired clearance by the LDL receptor. These complex alterations in li poprotein composition not only passively accompany chronic renal disease bu t on the contrary also promote its progression and the development of ather osclerosis, Therefore, renal patients with dyslipidemia should be subjected to lipid-lowering therapy. The effectiveness of lipid lowering on the redu ction of cardiovascular endpoints or the progression of renal disease is un der investigation or remains to be studied. Curr Opin Nephrol Hypertens 10: 195-101, (C) 2001 Lippncott Williams & Wilkins.