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Plasma lipoprotein abnormalities in hemodialysis patients--clinical implications and therapeutic guidelines.

Abstract

Patients with advanced stages of chronic kidney disease (CKD) have an increased risk of death from cardiovascular disease (CVD). Dyslipidemias are associated with atherosclerotic vascular changes and the risk of occurrence of acute myocardial infarction in hemodialysis patients. However, management of dyslipidemia in hemodialysis patients does not appear to be actively carried out in routine practice. Presumably, there are three reasons for this reluctance to lipid-lowering in hemodialysis patients. First, there are epidemiological data showing the inverse relationship between cholesterol and mortality rate; a high cholesterol predicts a better survival. Second, lipids are not usually measured using standard fasting serum, but a non-fasting specimen. Third, although hypertriglyceridemia is the most common abnormality, fibrates are contraindicated in patients with renal failure because of a high risk of rhabdomyolysis. These issues are discussed in the current review article. Based on published work, lipid lowering would not increase the death rate if carried out without worsening malnutrition. The National Kidney Foundation K/DOQI Clinical Practice Guidelines recommend a reduction in fasting LDL-C below 100 mg/dL for the prevention of CVD in dialysis patients. Practically, however, the use of non-HDL-C measured by casual blood samples might be sufficient for the risk assessment in many hemodialysis patients. Statins are a good choice for lipid-lowering in dialysis patients. Furthermore, lipoprotein profile might be improved by an inventive use of dialyzer membranes, dialysate solutions, and other dialysis-related medications. For severe hypercholesterolemia, LDL-apheresis is another choice for consideration. Further studies are needed to clearly prove the benefit of lipid reduction in hemodialysis patients and those with CKD at earlier stages.

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  • Authors+Show Affiliations

    ,

    Department of Metabolism, Endocrinology and Molecular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan. t-shoji@med.osaka-cu.ac.jp

    Source

    MeSH

    Atherosclerosis
    Blood Component Removal
    Cardiovascular Diseases
    Clinical Trials as Topic
    Dyslipidemias
    Humans
    Hypolipidemic Agents
    Kidney Failure, Chronic
    Life Style
    Lipoproteins
    Practice Guidelines as Topic
    Renal Dialysis
    Risk

    Pub Type(s)

    Journal Article
    Review

    Language

    eng

    PubMed ID

    16911182

    Citation

    Shoji, Tetsuo, and Yoshiki Nishizawa. "Plasma Lipoprotein Abnormalities in Hemodialysis Patients--clinical Implications and Therapeutic Guidelines." Therapeutic Apheresis and Dialysis : Official Peer-reviewed Journal of the International Society for Apheresis, the Japanese Society for Apheresis, the Japanese Society for Dialysis Therapy, vol. 10, no. 4, 2006, pp. 305-15.
    Shoji T, Nishizawa Y. Plasma lipoprotein abnormalities in hemodialysis patients--clinical implications and therapeutic guidelines. Ther Apher Dial. 2006;10(4):305-15.
    Shoji, T., & Nishizawa, Y. (2006). Plasma lipoprotein abnormalities in hemodialysis patients--clinical implications and therapeutic guidelines. Therapeutic Apheresis and Dialysis : Official Peer-reviewed Journal of the International Society for Apheresis, the Japanese Society for Apheresis, the Japanese Society for Dialysis Therapy, 10(4), pp. 305-15.
    Shoji T, Nishizawa Y. Plasma Lipoprotein Abnormalities in Hemodialysis Patients--clinical Implications and Therapeutic Guidelines. Ther Apher Dial. 2006;10(4):305-15. PubMed PMID: 16911182.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Plasma lipoprotein abnormalities in hemodialysis patients--clinical implications and therapeutic guidelines. AU - Shoji,Tetsuo, AU - Nishizawa,Yoshiki, PY - 2006/8/17/pubmed PY - 2007/1/26/medline PY - 2006/8/17/entrez SP - 305 EP - 15 JF - Therapeutic apheresis and dialysis : official peer-reviewed journal of the International Society for Apheresis, the Japanese Society for Apheresis, the Japanese Society for Dialysis Therapy JO - Ther Apher Dial VL - 10 IS - 4 N2 - Patients with advanced stages of chronic kidney disease (CKD) have an increased risk of death from cardiovascular disease (CVD). Dyslipidemias are associated with atherosclerotic vascular changes and the risk of occurrence of acute myocardial infarction in hemodialysis patients. However, management of dyslipidemia in hemodialysis patients does not appear to be actively carried out in routine practice. Presumably, there are three reasons for this reluctance to lipid-lowering in hemodialysis patients. First, there are epidemiological data showing the inverse relationship between cholesterol and mortality rate; a high cholesterol predicts a better survival. Second, lipids are not usually measured using standard fasting serum, but a non-fasting specimen. Third, although hypertriglyceridemia is the most common abnormality, fibrates are contraindicated in patients with renal failure because of a high risk of rhabdomyolysis. These issues are discussed in the current review article. Based on published work, lipid lowering would not increase the death rate if carried out without worsening malnutrition. The National Kidney Foundation K/DOQI Clinical Practice Guidelines recommend a reduction in fasting LDL-C below 100 mg/dL for the prevention of CVD in dialysis patients. Practically, however, the use of non-HDL-C measured by casual blood samples might be sufficient for the risk assessment in many hemodialysis patients. Statins are a good choice for lipid-lowering in dialysis patients. Furthermore, lipoprotein profile might be improved by an inventive use of dialyzer membranes, dialysate solutions, and other dialysis-related medications. For severe hypercholesterolemia, LDL-apheresis is another choice for consideration. Further studies are needed to clearly prove the benefit of lipid reduction in hemodialysis patients and those with CKD at earlier stages. SN - 1744-9979 UR - https://www.unboundmedicine.com/medline/citation/16911182/Plasma_lipoprotein_abnormalities_in_hemodialysis_patients__clinical_implications_and_therapeutic_guidelines_ L2 - https://doi.org/10.1111/j.1744-9987.2006.00382.x DB - PRIME DP - Unbound Medicine ER -