Response of plasma triglycerides to dietary change in patients on hemodialysis

Sanfelippo, M L; Swenson, Robert S.; Reaven, Gerald M.

doi:10.1038/ki.1978.105

Cited by 60 publications

(9 citation statements)

References 21 publications

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“…Low ering of fasting or postprandial plasma tri glycerides in response to a selectively low carbohydrate diet was described by Sanfelippo et al [61] in HD patients. Similar observations by Cattran et al [62] docu mented a decrease of VLDL and LDL and an increase of HDL in response to low-carbohy drate, high-P/S diets.…”

Section: Hemodialysis and Peritoneal Dialysismentioning

confidence: 99%

Hyperlipoproteinemia in Chronic Renal Failure: Pathophysiological and Therapeutic Aspects

Wanner¹,

Frommherz²,

Hörl³

1991

Cardiology

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Dyslipidemia of chronic renal failure is of multifactorial origin. Decreased activity of lipoprotein lipase and hepatic triglyceride lipase, peripheral insulin resistance, hyperparathyroidism and L-carnitine deficiency are the contributing factors. This results in a disturbed catabolism of chylomicron, accumulation of very-low-density (VLDL) and intermediate-density (IDL) lipoproteins as well as incompletely cleared remnant particles, whereas low-density lipoprotein (LDL) levels are diminished. There is current debate as to whether cardiovascular disease is accelerated and whether hyperlipidemia should specifically be treated. In addition, there have been few means of influencing these metabolic alterations. Drug incompatibility and consequently side effects render treatment difficult. The drugs that have been most tested for lipid lowering in chronic renal failure are the fibric acids. By their mode of action, they are the logical choice. Dose reduction overcomes major side effects such as myopathy and rhabdomyolysis. The second generation of fibric acid derivatives (gemfibrozil and beclobrate) show several advantages over formerly used derivatives. Treatment with lovastatin and simvastatin appears to be safe and is recommended in a minority of patients with predominantly elevations of LDL. HMG-CoA reductase inhibitors also lower remnant particles effectively in hemodialysis (HD) patients. L-Carnitine and low-molecular-weight heparin have been shown to influence VLDL rich in triglycerides in a subset of patients on HD. In posttransplant hyperlipidemia, diet remains the first course of action in all patients. When this approach fails, the new lipid-lowering agents, especially fibric acids, appear to be safe in short-term studies in azathioprine- and ciclosporin-treated patients. Lovastatin has been shown to be safe in stable renal transplant patients. Its toxicity seems to depend mainly on high ciclosporin whole blood through or plasma levels.

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Section: Hemodialysis and Peritoneal Dialysismentioning

confidence: 99%

Hyperlipoproteinemia in Chronic Renal Failure: Pathophysiological and Therapeutic Aspects

Wanner¹,

Frommherz²,

Hörl³

1991

Cardiology

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“…Only 7% reduction in carbo hydrate content of polyunsaturated fat diet compared to the conventional diet does not seem to be responsible for a 28% fall in serum triglyceride levels observed during polyunsaturated fat diet, since as much as 17% reduction in carbohydrate content of a saturated fat diet caused only a 23% decrease in serum triglyceride levels in our previous study [7], In the present study, serum triglyceride levels increased again in 5 of 6 patients after ingestion of satu rated fat and low carbohydrate diet. Sanfelippo et al [22] studied the effect of polyunsaturated fat diet on serum tri glyceride levels in hemodialyzed patients with CRF. A significant difference in the lessening of the fasting tri glyceride levels between a 'low carbohydrate polyunsatu rated fat diet' and a 'low carbohydrate saturated fat diet' was inadequately shown.…”

Section: Discussionmentioning

confidence: 99%

Effects of a Polyunsaturated Fatty Acid-Rich Diet on Serum Lipids in Patients with Chronic Renal Failure

Tsukamoto

Okubo

Yoneda

et al. 1982

Nephron

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An abnormal level of serum lipids may be one of the major risk factors for the development of atherosclerosis in patients with chronic renal failure (CRF). In the present study, the effect of polyunsaturated fatty acid-rich and low carbohydrate diet on serum lipids and HDL-cholesterol was studied in 6 nonnephrotic and nondialyzed patients with CRF on an isocaloric basis. Serum triglycerides decreased significantly from 2.08 ± 0.93 mmol/l (183 ± 82 mg/dl) to 1.49 ± 0.83 mmol/l (131 ± 73 mg/dl) by consumption of polyunsaturated diet (p < 0.01). The ‘HDL-cholesterol ratio’ increased significantly and LCAT decreased on a polyunsaturated diet. In conclusion, the consumption of a polyunsaturated fatty acid-rich diet tends to normalise increased serum triglycerides and lowered ‘HDL-cholesterol ratio’ in patients with CRF and may be effective for prevention of atherosclerotic vascular sequellae.

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“…Hyperparathyroidism, drugs and dialysis kinetics all have been implicated in the pathogenesis of the uremic hyper lipidemia [7], Treatment modalities include lipid lowering drugs, all rather toxic, absorbents and changes in the type and efficiency of dialysis [21][22][23]. The most promising therapeutic approach, however, seems to be that of dietary restriction of carbohydrates [24][25][26].…”

Section: Discussionmentioning

confidence: 99%

Impaired Intestinal Fat Absorption in Chronic Renal Failure

Drukker¹,

Lévy²,

Bronza³

et al. 1982

Nephron

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We performed oral fat loading tests in 10 patients with chronic renal failure (CRF) on hemodialysis (5 children and 5 adults). Fat absorption was measured by hourly determination of serum triglycerides (TG), cholesterol (CHOL), and lipoproteins (LP) after oral administration of a ‘milkshake’ containing 50 g of fat of dairy origin. 10 age-matched healthy volunteers with normal fasting serum TG levels and 10 subjects with fasting hypertriglyceridemia served as controls. Mean fasting serum TG levels in CRF patients were elevated compared to normal controls (177.6+14.6 mg/dl, 2.0+17 mmol/l vs. 91.0+10.5 mg/dl, 1.03 + 12 mmol/l). 6 patients (4 adults, 2 children) had type IV LP patterns and 2 patients (both children) showed type lib hyperlipidemia. In only 2 patients, 1 child and 1 adult, were TG, CHOL and LP electrophoresis all normal. The oral fat loading test in all CRF patients showed delayed appearance of TG and chylomicrons (CHYL) in the bloodstream i. c. impaired or slow absorption of fat from the gut. In contrast to normal and hypertriglyceridemic controls, TG and CHYL levels in CRF did not decrease by 5 h after the oral fat load.This study demonstrates impaired intestinal fat absorption in children and adults with CRF.

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Response of plasma triglycerides to dietary change in patients on hemodialysis

Cited by 60 publications

References 21 publications

Hyperlipoproteinemia in Chronic Renal Failure: Pathophysiological and Therapeutic Aspects

Hyperlipoproteinemia in Chronic Renal Failure: Pathophysiological and Therapeutic Aspects

Effects of a Polyunsaturated Fatty Acid-Rich Diet on Serum Lipids in Patients with Chronic Renal Failure

Impaired Intestinal Fat Absorption in Chronic Renal Failure

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