Objective Oyslipidemia possibly contributes to the vascular complications commonly afflicting uremic patients. Lipoprotein (a) [Lp(a)] has been identified as an independent risk factor for atherosclerotic vascular dis ease. The aim of our study was to compare lipidparameters, including Lp(a), between hemodialysis (HO) and continuous ambulatory peritoneal dialysis (CAPO) patients. Design A cross-sectional study. Setting University Medical Center. Participants Forty CAPO and 40 HO patients carefully matched for age, sex, body mass index (BMI), smoking habits, and duration of dialysis were studied. A group of 40 healthy individuals matched for age, sex, BMI, and smoking habits was used as control. Interventions None. Main Outcome Measures Serum lipid parameters and atherogenic risk ratios were the main outcome measures. Results Both groups of dialysis patients had increased serum triglycerides and decreased levels of Apo AI and HOL cholesterol compared to controls. Moreover, the risk ratios total cholesterol/HOL cholesterol and LOL cholesterol/HOL cholesterol were significantly higher, and the ratio ApoA1/ApoB was significantly lower in both groups of patients in comparison to the normal subjects. Both groups of dialysis patients exhibited decreased ratios of LOL cholesterol/ApoB and HOL cholesterol/ApoAI, suggesting the presence of compositional lipoprotein changes. CAPO patients had a more atherogenic lipid profile compared to HO patients, since they exhibited higher levels of total and LOL cholesterol, of ApoB as well as of the ratios total cholesterol/HOL cholesterol and LOL cholesterol/ HOL cholesterol, and lower levels of the ratio ApoA1/ApoB compared to HO patients. Both groups of dialysis patients had increased serum Lp(a) levels. Even though CAPO patients had higher serum Lp(a) levels than HO patients, the differences between these two groups were only marginally statistically significant (p = 0.056 by Mann-Whitney U-test). Uremic dyslipidemia was positively correlated with serum albumin levels in both groups of patients. Conclusion CAPO patients exhibit a more atherogenic lipid profile than that of HO patients. The marked disturbances in Lp(a) levels may further increase the vascular risk in both groups of patients.

Cardiovascular disease is one of the major causes of death in hemodialysis patients and seems to be related, at least in part, to lipid abnormalities. It has been suggested that in these patients low-molecular-weight heparin (LMWH) is superior to conventional heparin because it causes less side effects and has beneficial effects on lipid parameters. Our study was carried out to examine the long-term effects of the replacement of conventional heparin by LMWH on the lipoprotein profile in a large group of hemodialysis patients. A total of 76 patients aged 15-61 years receiving hemodialysis for 48 (range 10-169) months were studied. In all patients administration of LMWH was introduced in doses of 2,500-5,000 anti-factor Xa units for 12 months. Then, we randomly switched half of the patients back to conventional heparin for another 12 months, while the remaining patients continued to receive LMWH for 12 months. In the whole group of patients the use of LMWH instead of conventional heparin was followed by a significant decrease in serum total cholesterol, triglyceride and apoprotein B levels. The continued use of LMWH for another 12 months in half of the patients was followed by a further significant improvement in the lipid profile. In contrast, no significant changes in serum lipid parameters were observed in patients switched back to conventional heparin. In conclusion, the use of LMWH instead of conventional heparin for anticoagulation during hemodialysis is followed by an improvement in lipid profile, which is evident only after long-term treatment.

Familial Hyperholesterolaemia (FH) is a clinical syndrome characterised by elevated serum total cholesterol levels due to an increase in low density lipoprotein (LDL) cholesterol, by tendon xanthomata and clinical manifestations of ischaemic heart disease in early life. Typically, it results from mutations in the low-density lipoprotein receptor (LDLR) gene. So far, over 600 mutations have been reported for the LDLR gene and account for FH. The nature of LDLR gene mutations is different in various ethnicities and has also regional distribution within each ethnicity. Eleven mutations have already been described in the Greek population. This report describes seven LDLR gene mutations accounting for FH in Northwestern Greece (81T>G, 517T>C, 858C>A, 1285G>A, 1352T>C, 1646G>A and 1775G>A) and their geographic distribution. We have recently described one of these mutations (1352T>C) as a novel point mutation in a Greek family originating from Northwestern Greece. Furthermore, two previously identified mutations (81T>C, 1775G>A) were also detected in the Greek FH patients for the first time. The 1775G>A mutation was responsible for all the homozygous patients in our area, indicating a founder effect. These data will favor the development of tailed information and screening programs in Northwestern Greece for the primary prevention of cardiovascular disease in FH patients.

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Chronic hemodialysis (CHD) patients have a high incidence and prevalence of atherosclerotic disease which may be related to numerous atherosclerotic risk factors. Among them dyslipidemia plays a significant role. Elevated Lp(a) levels, which are strongly associated with atherosclerosis, have been reported recently in uremic patients. The aim of our study was the determination of the levels of lipid parameters including Lp(a) in 151 CHD patients (76 male) aged 57 (12-81) years, who were on hemodialysis for a mean of 44.3 (range 1 to 189) months. Eighty-four normal individuals age and sex matched were used as controls. The median serum Lp(a) concentration in hemodialysis patients was 13 mg/dL compared with 6.5 mg/dL in healthy controls, p < 0.001 by distribution-free Mann-Whitney test. The prevalence of subjects with Lp(a) levels above 25 mg/dL was significantly higher in CHD patients compared to normal subjects (30% vs. 8%, p < 0.001). Even if CHD patients were matched for fasting lipid levels, they showed Lp(a) levels significantly higher than controls. No significant correlation was found between Lp(a) levels and either the age of the patients or the duration of hemodialysis. The etiology of primary renal disease did not influence the Lp(a) levels.