Racial Differences in Plasma High-Density Lipoproteins in Patients Receiving Hemodialysis

Goldberg, Andrew P.; Harter, Herschel R.; Patsch, Wolfgang; Schechtman, Kenneth B.; Province, Michael; Weerts, Carol; Kuisk, Ilmar; McCrate, M. M.; Schonfeld, Gustav

doi:10.1056/nejm198305263082101

Cited by 69 publications

(27 citation statements)

References 35 publications

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“…Apo A-II concentrations were very similar in all three groups. Because different apo A-I/A-II ratios have been reported in different HDL subspecies (29), this finding is consistent with reported differences in the HDL subspecies distribution in ESRD patients (13). The levels of apo E were in the normal range in both ESRD groups, as were the apo B levels.…”

Section: Resultssupporting

confidence: 89%

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Plasma cholesterol metabolism in end-stage renal disease. Difference between treatment by hemodialysis or peritoneal dialysis.

Dieplinger¹,

Schoenfeld²,

Fielding³

1986

J. Clin. Invest.

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Plasma cholesterol metabolism was investigated in normotriglyceridemic patients with end-stage renal disease treated by hemo-or continuous ambulatory peritoneal dialysis (CAPD), and compared with that in a control group with normal renal function. A reversed net transport of free cholesterol from plasma to cultured fibroblasts, as well as greatly reduced levels of plasma cholesterol esterification and cholesterol ester transfer rates to low and very low density lipoproteins (LDL and VLDL), was found in the hemodialysis group compared to the controls. The LDL and VLDL contained increased amounts of free cholesterol and inhibited cholesterol ester transfer when recombined with control plasma. The LDL triglyceride content was doubled in the hemodialysis group, whereas cholesterol esters were decreased. Patients treated by CAPD, in marked contrast, had cholesterol metabolic rates that were within the normal range, as well as normal lipoprotein composition.

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Section: Resultssupporting

confidence: 89%

“…The composition of HDL has been studied in some detail (13). Apoprotein (apo) A-I, the major apoprotein of HDL, has been reported as normal (1 1) and decreased (9) in patients on hemodialysis.…”

Section: Introductionmentioning

confidence: 99%

Plasma cholesterol metabolism in end-stage renal disease. Difference between treatment by hemodialysis or peritoneal dialysis.

Dieplinger¹,

Schoenfeld²,

Fielding³

1986

J. Clin. Invest.

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“…High density lipoprotein (HDL) cholesterol is decreased in patients with CRF [3,4] while the amount of HDL, IDL and LDL cholesterol is increased. Changes in lipoprotein composition occur early in the course of renal failure [5], suggest ing that abnormalities in lipoprotein levels are a consequence of renal failure per se, and not a consequence of dialysis.…”

mentioning

confidence: 99%

Hyperlipidemia of Chronic Renal Failure

Kaysen

1994

Blood Purif

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Plasma triglycerides are increased in the majority of patients with advanced renal failure but cholesterol is not. HDL cholesterol is reduced while LDL IDL and VLDL cholesterol is increased. Lecithin:cholesterol acyltransferase (LCAT), an enzyme necessary for HDL maturation, is reduced in chronic renal failure (CRF). As a consequence, while all subtypes of HDL are reduced, the small HDL₃ subtype is relatively enriched at the expense of the larger, more functional HDL₂ subtype. Triglycerides are increased in all lipoprotein fractions. HDL-associated apolipoproteins, apo A-I and A-II are decreased, while apo B is increased. Lipoprotein catabolic rate is reduced, but the cause of hyperlipidemia is multifactorial; reduced lipoprotein lipase (LPL) activity, increased concentration of apo C-III (a specific inhibitor of LPL) in plasma, secondary hyperparathyroidism, insulin resistance. Hyperlipidemia is not corrected by dialysis. Lipid levels are somewhat higher in CAPD patients, possibly as a consequence of increased glucose absorption or as a consequence of transperitoneal HDL losses. Triglycerides decrease and cholesterol increases following transplantation. Oxidized lipids are increased in plasma of patients with CRF. Plasma polyunsaturated fatty acids are decreased and saturated fatty acids increased. The same changes occur in the lipid bilayers composing leukocytes and red blood cell membranes. These changes result in altered membrane fluidity, and are corrected by dialysis. While atherosclerotic disease is a leading cause of death in dialysis patients, it is not certain that the specific lipid disorders of CRF are responsible for this morbidity, nor is it recommended at this time that qualitative abnormalities be treated pharmacologically in the absence of increased lipid levels.

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“…In addition, high-density lipoprotein cholesterol (HDL-C) is decreased in this group of patients [9,10]. However, the mechanisms responsible for the uremic dyslipidemia are only partially understood.…”

Section: Introductionmentioning

confidence: 99%

Effects of Treatment of Secondary Hyperparathyroidism on the Lipid Profile in Patients on Hemodialysis

Lim¹,

Hung²,

Yeh³

et al. 1998

Blood Purif

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Abnormalities in circulating lipoprotein concentrations are a characteristic finding in patients undergoing dialytic therapy. A substantial number of these patients display type IV hyperlipoproteinemia. Certain data suggest that secondary hyperparathyroidism may induce disturbances in lipid metabolism. To evaluate the effects of pulse calcitriol therapy on the lipid profile in these patients, we undertook a prospective study in 12 patients on stable bicarbonate hemodialysis. Lipid parameters comprising cholesterol and the low- as well as the high-density lipoprotein subfractions, triglycerides, apolipoproteins A and B, serum parathyroid hormones (iPTH), alkaline phosphatase, calcium, phosphorus, hematocrit, and blood urea were obtained prior to commencement of pulse calcitriol therapy and again 8–10 weeks later. Calcitriol therapy was associated with a decrease in serum iPTH levels (701 ± 103.9 vs. 220.3 ± 50.5 pmol/l; p < 0.001). Significant increases in high-density lipoprotein cholesterol (32.8 ± 2.7 vs. 38.8 ± 2.3 mmol/l; p < 0.05) and apolipoprotein A-I (107.8 ± 6.1 vs. 121.8 ± 5.8 g/l; p < 0.05) were noted during the course of the study. Moreover, serum iPTH correlated inversely with high-density lipoprotein cholesterol and apolipoprotein A-I. There were no changes in other lipid parameters except for low-density lipoprotein cholesterol which showed a tendency to increase. We conclude that in short-term study, pulse oral calcitriol therapy is associated with an improvement in the lipid profile in patients with secondary hyperparathyroidism. However, it remains to be established whether ameliorating the uremic dyslipidemia results in any long-term clinical benefits.

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Racial Differences in Plasma High-Density Lipoproteins in Patients Receiving Hemodialysis

Cited by 69 publications

References 35 publications

Plasma cholesterol metabolism in end-stage renal disease. Difference between treatment by hemodialysis or peritoneal dialysis.

Plasma cholesterol metabolism in end-stage renal disease. Difference between treatment by hemodialysis or peritoneal dialysis.

Hyperlipidemia of Chronic Renal Failure

Effects of Treatment of Secondary Hyperparathyroidism on the Lipid Profile in Patients on Hemodialysis

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