Lipid Parameters Including Lipoprotein (A) in Patients Undergoing CAPD and Hemodialysis

Abstract

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.

Effects of l‐carnitine supplement on serum inflammatory cytokines, C‐reactive protein, lipoprotein (a), and oxidative stress in hemodialysis patients with Lp (a) hyperlipoproteinemia

“…High serum Lp (a) concentration is a common lipid disorder in dialysis patients, 8,[23][24][25] and hyper Lp (a) constitute a major risk factor for CVD. [26][27][28][29][30] However, no effective treatment to reduce Lp (a) in these patients has been known so far. 8 In the present study, serum Lp 9,10 Oxidative stress is also a common complication in hemodialysis patients and can result in various complications such as CVD.…”

Lipoprotein Profiles at Different Stages of Chronic Renal Insufficiency

“…The observed decrease of parameters in the lipoprotein pro®le in patients of CR1-C creatinine >10 mg/dL did not exclude disturbances in its metabolism because apoAI levels decreased in our uremic patients compared with controls, and the HDLC/apoAI ratio was also signi®cantly lower. This fact con®rms the occurrence of qualitative changes in the composition of HDL at the early stages of CR1 (7,8). A reduced cholesterol esteri®cation in HDL particles in conjunction with a reduced concentration of apoAI and apoAII may contribute to reduced plasma HDL cholesterol (25,26).…”

“…Altered synthesis of proteins, which are the components of lipoproteins may also participate in the abnormal lipoprotein pro®le in the uremic patients (25). Inverse correlation was shown between TG and HDL-C and TO and HDL-C/apoAI ratio, suggesting that compositional HDL changes were closely related to the hypertriglyceridemic stage (7,8). Elisaf et al (7) reported that in such cases transfer of cholesterol esters from HDL to VLDL, and triglycerides from VLDL to HDL takes place, resulting in the appearance of smaller and denser HDL particles containing decreased amounts of cholesterol.…”

“…The disturbances are also caused by decreased ratio of apo AI to apoB. This ratio is generally accepted to represent an index of the degree to which lipoprotein pro®les protect against atherosclerosis (3,7,8). The renal dyslipoproteinemia may contribute not only to accelerated development of atherosclerosis (2±10) but also to progression of human chronic renal insuciency (11±17).…”

The comparison of risk of stroke in patients with peritoneal dialysis and hemodialysis: A systematic review and meta‐analysis

“…While HD causes more fluctuations in volume, blood pressure and hemodynamics, [39][40][41] PD is associated with exposure to relatively high glucose load in the dialysate, which may cause hyperglycemia 42 or unfavorable lipid profile 43 and add to higher vascular atherosclerosis and stroke. HD also requires vascular access, which may be prone to complications such as thrombosis, embolization, or endocarditis.…”