Is There a Treatment Necessity for Lipid Disorders of Uremic Patients?

Lacour, Bernard; Roullet, Jean Baptiste; Beyne, Pascale; Drüeke, Tilman B.

doi:10.1159/000169397

Cited by 2 publications

(3 citation statements)

References 28 publications

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“…Third, no cytokines were measured in our patients, which may interact with the effect of cholesterol on survival in HD patients. Finally, we did not clarify the effect of hypercholesterolemia on MHD mortality due to the lower percentage of hypercholesterolemia patients and the frequency of events [19] . Further prospective studies are required to establish a target level of serum TC and LDL-C that will reduce the risk of mortality in dialysis patients.…”

Section: Discussionmentioning

confidence: 93%

Low-Density Lipoprotein Cholesterol: Association with Mortality and Hospitalization in Hemodialysis Patients

Chiang

Hsu

et al. 2005

Blood Purif

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Background/Aims: Hypocholesterolemia is a common finding in hospitalized elderly people, critically ill surgical patients, septic patients and end-stage renal disease patients. The different effect of lipid subfractions on patients with end-stage renal disease has never been demonstrated. We aim to study the effect of lipid subfractions on hospitalization and mortality in maintenance hemodialysis (MHD) patients. Methods: Lipid subfractions, including total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C) were measured in 210 patients with MHD in a single dialysis center. Patients were stratified into three groups based on the tertiles of lipid levels, and differences in patient characteristics and survival were evaluated. Results: Of a total of 22 deceased patients in our MHD cohort, infection-related mortality (50%) was higher than cardiovascular-related mortality (18.2%). Significant differences (p < 0.05) in the duration and frequency of hospitalization and in mortality events were observed when patients were divided into different subgroups according to the tertiles of baseline TC and LDL-C levels. Patients with lower LDL had significantly lower levels of albumin, TC and TG. The LDL-C tertiles were similar in terms of age, hypertension, diabetes, biochemical results, hematocrit, adequacy of hemodialysis and normalized protein catabolism rate. Both TC and LDL-C predicted survival (p < 0.001), but not TG and HDL-C in the Kaplan-Meier model. The Cox proportional hazard model demonstrated that baseline serum LDL-C was the best lipid subfraction in predicting all-cause death with an adjusted hazard ratio (95% confidence interval) for each 10 mg/dl of 0.752 (0.631–0.898; p = 0.002). Conclusions: We firstly demonstrated that lipid subfractions, including TC and LDL-C, predict poor outcomes in a MHD cohort with high infection-related mortality.

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Section: Discussionmentioning

confidence: 93%

Low-Density Lipoprotein Cholesterol: Association with Mortality and Hospitalization in Hemodialysis Patients

Chiang

Hsu

et al. 2005

Blood Purif

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“…When deciding whether the hyperlipemia of a patient on dialysis should be treated, the data exposed by Wing et al [15] should be remembered: of the 56,000 deaths of patients on dialysis 52% were due to a cardiovascular disorder; this seems to indicate that patients on dialysis have a trend towards cardiovascular risk, which could be related to the high incidence of hyperlipemia in these patients [5], The association with diabetes mellitus, with its own risks of atherogenesis, makes the treatment of hyperlipemia compulsory.…”

Section: Discussionmentioning

confidence: 99%

“…Diabetic renal disease is, at present, one of the more frequent causes which leads to ESRD and therefore to dialysis schedules [4], From all that has been mentioned above the inci dence of hyperlipemia in diabetic patients on dialysis and the necessity to reduce the lipid levels is deduced, in an attempt to reduce the cardiovascular risk which its accumulation can produce [5], The use of hypolipemic diets, whose effectiveness has been proved [6], is diffi cult to maintain in the uremic diabetic patient who already has excessive diet limitations. The drugs that are used normally in hyperlipemia have side effects and severe contraindications in ESRD [7], The aim of this study is to evaluate the use of pantethine in a group of diabetic patients on dialysis.…”

Section: Introductionmentioning

confidence: 99%

Treatment of Hyperlipemia in Diabetic Patients on Dialysis with a Physiological Substance

Coronel

Tornero²,

Torrente³

et al. 1991

Am J Nephrol

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Hyperlipemia is a very frequent complication of the diabetic patient on dialysis. There is difficulty of treatment with the diet, because the dietary restriction already imposed on these patients and the secondary effects and toxicity of the available drugs in uremics aggravate the problem. We have treated 22 diabetic patients on dialysis (8 on hemodialysis and 14 on continuous ambulatory peritoneal dialysis) suffering from hyperlipemia with pantethine, a physiological substance and coenzyme A precursor in the Krebs eycle. With the administration of an oral dose of 900mg/day we obtained a reduction of total cholesterol (275 ± 72 vs. 231 ± 54mg/dl; p < 0.001), very-low-density lipoprotein (VLDL)-cholesterol (66 ± 36 vs. 46 ± 18 mg/dl; p < 0.01) and triglycerides (332 ± 182 vs. 227 ± 90 mg/dl; p < 0.01) at 2 months. High-density lipoprotein (HDL)-cholesterol did not change, but the total cholesterol/HDL-cholesterol ratio decreased significantly (p < 0.05). Total cholesterol, VLDL and triglycerides showed a progressive and significant reduction at 4 and 6 months. No changes were observed in serum glutamic oxaloacetic transaminase, serum glutamic pyruvic transaminase, uric acid, blood glucose and glycosylated hemoglobin. Gastric discomfort in 2 patients and pruritus in another one were the secondary effects related. Pantethine was shown to be a very effective hypolipemic agent in diabetic patients on dialysis with a great tolerance.

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Is There a Treatment Necessity for Lipid Disorders of Uremic Patients?

Cited by 2 publications

References 28 publications

Low-Density Lipoprotein Cholesterol: Association with Mortality and Hospitalization in Hemodialysis Patients

Low-Density Lipoprotein Cholesterol: Association with Mortality and Hospitalization in Hemodialysis Patients

Treatment of Hyperlipemia in Diabetic Patients on Dialysis with a Physiological Substance

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