Dyslipidemia in patients with chronic kidney disease: etiology and management

Abstract

Abstract:Patients with chronic kidney disease (CKD), including those with end-stage renal disease, treated with dialysis, or renal transplant recipients have an increased risk for cardiovascular disease (CVD) morbidity and mortality. Dyslipidemia, often present in this patient population, is an important risk factor for CVD development. Specific quantitative and qualitative changes are seen at different stages of renal impairment and are associated with the degree of glomerular filtration rate declining. Patients with non-dialysis-dependent CKD have low high-density lipoproteins (HDL), normal or low total cholesterol (TC) and low-density lipoprotein (LDL) cholesterol, increased triglycerides as well as increased apolipoprotein B (apoB), lipoprotein(a) (Lp (a)), intermediate-and very-low-density lipoprotein (IDL, VLDL; "remnant particles"), and small dense LDL particles. In patients with nephrotic syndrome lipid profile is more atherogenic with increased TC, LDL, and triglycerides. Lipid profile in hemodialysis (HD) patients is usually similar to that in non-dialysis-dependent CKD patients. Patients on peritoneal dialysis (PD) have more altered dyslipidemia compared to HD patients, which is more atherogenic in nature. These differences may be attributed to PD per se but may also be associated with the selection of dialytic modality. In renal transplant recipients, TC, LDL, VLDL, and triglycerides are elevated, whereas HDL is significantly reduced. Many factors can influence post-transplant dyslipidemia including immunosuppressive agents. This patient population is obviously at high risk; hence, prompt diagnosis and management are required to improve their clinical outcomes. Various studies have shown statins to be effective in the cardiovascular risk reduction in patients with mild-to-moderate CKD as well as in renal transplant recipients. However, according to recent clinical randomized controlled trials (4D, A Study to Evaluate the Use of Rosuvastatin in Subjects on Regular Dialysis: an Assessment of Survival and Cardiovascular Events, and Study of Heart and Renal protection), these beneficial effects are uncertain in dialyzed patients. Therefore, further research for the most suitable treatment options is needed.

Relationship between Plasma Proprotein Convertase Subtilisin/Kexin Type 9 and Estimated Glomerular Filtration Rate in the General Chinese Population

“…These changes could be observed in the early stages of kidney disease [25,26], and serious kidney dysfunction led to the development of severe dyslipidemia [2,3,27]. In our study, we found a higher LDL-C level in the decreased eGFR group compared to the normal eGFR group.…”

“…Previous studies have indicated that patients with kidney disease also exhibit significant alterations in lipid metabolism and that the progression of kidney disease may lead to severe dyslipidemia [2][3][4]. Importantly, it is worth noting that disorders in lipid metabolism can also be observed in patients even in the early stage of kidney dysfunction [5,6].…”

The effect of dialysis type on left atrial functions in patients with end‐stage renal failure: A propensity score‐matched analysis

“…The function and size of the left atrium are influenced by various factors including mitral valve disease, hypertension, obesity, and intrinsic LA disorders and particularly systolic and diastolic functions of LV. With the development of left ventricular diastolic dysfunction, LA is chronically exposed to abnormal filling pressures, which end up with volumetric changes . In our study, IVS increased in both groups as compared to normal healthy population, but the increase in the HD group was more notable and statistically significant, and we implied that the presence of ventricular hypertrophy in HD patients may contribute to left atrial dysfunction due to the above‐mentioned conditions.…”

“…function, LA is chronically exposed to abnormal filling pressures, which end up with volumetric changes. 5,[9][10][11][12] In our study, IVS increased in both groups as compared to normal healthy population, but the increase in the HD group was more notable and statistically significant, and we implied that the presence of ventricular hypertrophy in HD patients may contribute to left atrial dysfunction due to the abovementioned conditions.…”

A Pre-transplant Blood-based Lipid Signature for Prediction of Antibody-mediated Rejection in Kidney Transplant Patients

“…Future larger studies with an increased sample size would be need to confirm this preliminary study. Our finding of hyperlipidemia in AMR group could be linked to the fact that hyperlipidemia is the most common form of dyslipidemia, a common complication in CKD patients, associated with the decline in kidney function, hypertriglyceridemia, low HDL, and low or normal LDL (34).…”