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Is lipid control necessary in hemodialysis patients?
Clin J Am Soc Nephrol 2009; 4 Suppl 1:S95-101CJ

Abstract

Although high serum total cholesterol and LDL cholesterol levels are predictive of cardiovascular diseases in the general population, this association is more complex in the dialysis patients. Two recent randomized trials failed to show significant beneficial effects of statins on the primary cardiovascular outcomes in these patients. The reasons for this lack of benefits are unclear. The postulates include the possibilities that LDL cholesterol is not important in atherogenesis and that atherosclerosis is not a major contributor to cardiovascular diseases in the dialysis population. It is important to note that high serum LDL cholesterol level is not a prominent feature of uremic dyslipidemia. Instead, the hallmark dyslipidemias in the dialysis population are hypertriglyceridemia as a result of the accumulation of lipoprotein remnant particles, low serum HDL cholesterol levels, high serum levels of lipoprotein(a) [Lp(a)], and the modification of LDL cholesterol by oxidation and carbamylation. In vitro and epidemiologic studies have further suggested that these abnormal lipoproteins or aberrant serum lipoprotein levels are atherogenic. More research efforts should be directed toward these dyslipidemic states and the multitude of other putative cardiovascular risk factors in dialysis patients.

Authors+Show Affiliations

Medical Service, Veterans Affairs Salt Lake City Healthcare System and Division of Nephrology and Hypertension and Dialysis Program, University of Utah, Salt Lake City, Utah, USA. alfred.cheung@hsc.utah.edu

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

19996012

Citation

Cheung, Alfred K.. "Is Lipid Control Necessary in Hemodialysis Patients?" Clinical Journal of the American Society of Nephrology : CJASN, vol. 4 Suppl 1, 2009, pp. S95-101.
Cheung AK. Is lipid control necessary in hemodialysis patients? Clin J Am Soc Nephrol. 2009;4 Suppl 1:S95-101.
Cheung, A. K. (2009). Is lipid control necessary in hemodialysis patients? Clinical Journal of the American Society of Nephrology : CJASN, 4 Suppl 1, pp. S95-101. doi:10.2215/CJN.04780709.
Cheung AK. Is Lipid Control Necessary in Hemodialysis Patients. Clin J Am Soc Nephrol. 2009;4 Suppl 1:S95-101. PubMed PMID: 19996012.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Is lipid control necessary in hemodialysis patients? A1 - Cheung,Alfred K, PY - 2009/12/10/entrez PY - 2010/1/9/pubmed PY - 2010/3/12/medline SP - S95 EP - 101 JF - Clinical journal of the American Society of Nephrology : CJASN JO - Clin J Am Soc Nephrol VL - 4 Suppl 1 N2 - Although high serum total cholesterol and LDL cholesterol levels are predictive of cardiovascular diseases in the general population, this association is more complex in the dialysis patients. Two recent randomized trials failed to show significant beneficial effects of statins on the primary cardiovascular outcomes in these patients. The reasons for this lack of benefits are unclear. The postulates include the possibilities that LDL cholesterol is not important in atherogenesis and that atherosclerosis is not a major contributor to cardiovascular diseases in the dialysis population. It is important to note that high serum LDL cholesterol level is not a prominent feature of uremic dyslipidemia. Instead, the hallmark dyslipidemias in the dialysis population are hypertriglyceridemia as a result of the accumulation of lipoprotein remnant particles, low serum HDL cholesterol levels, high serum levels of lipoprotein(a) [Lp(a)], and the modification of LDL cholesterol by oxidation and carbamylation. In vitro and epidemiologic studies have further suggested that these abnormal lipoproteins or aberrant serum lipoprotein levels are atherogenic. More research efforts should be directed toward these dyslipidemic states and the multitude of other putative cardiovascular risk factors in dialysis patients. SN - 1555-905X UR - https://www.unboundmedicine.com/medline/citation/19996012/Is_lipid_control_necessary_in_hemodialysis_patients L2 - http://cjasn.asnjournals.org/cgi/pmidlookup?view=long&pmid=19996012 DB - PRIME DP - Unbound Medicine ER -