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CZECH MEDICAL ASSOCIATION J. Ev. PURKYNĚ |
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Česky / Czech version | Vnitřní lékařství, 46, 2000, č. 9, s. 539 - 546 |
Dyslipoproteinaemia and Chronic Renal Failure Zahálková J., Vaverková H., Krištof V. III. interní klinika FN a LF UP, Olomouc, přednosta prof. MUDr. V. Ščudla, CSc. |
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Summary: Lipoprotein abnormalities are a regular part of metabolic changes associated with chronic renal
failure. The character of dyslipoproteinaemia changes with the severity of disorders of renal
functions, from intial deviations in the composition and distribution of circulating lipoprotein
particles (a decline of glomerular filtration to 0.7 - 0.8 ml/s) to differently expressed changes of
plasma lipid concentrations in terminal renal failure.
The basis of the pathogenetic mechanism of these lipid abormalities is the negative effect of the
uraemic environment on the formation and catabolism of triglyceride-risck lipoproteins and on
the function of the reverse cholesterol transport. An important part is also played by the modifi-
cation of lipoprotein particles by oxidation and glycation. To a different extent also the nutritio-
nal status is manifested via the unfavourable composition of dietary fats, reduced effectiveness of
antioxidant factors and in some instances also carnitine deficiency. Haemodialysis treatment and
in particular peritoneal dialysis modify these lipid abnormalities.
From the qunatitative aspect renal dyslipoproteinaemia is not very striking, despite this its
quantitative changes are important. It may have a negative impact on the progression of renal
disease by its participation in the development of glomerular sclerosis and tubulointerstitial
fibrosis. As one of the important risk factors it participates also in the acceleration of atheroscle-
rosis in patients with chronic renal failure and in their much higher cardiovascular mortality as
compared with the general population. These factors justify efforts to influence uraemic dyslipop-
roteinaemia. Fibrates or statins are indicated in conjunction with the supporting effect of diet
and modification of the dialysis regimen.
In tables and figures some results assembled by the authors are presented obtained in a group of
dialyzed patients (characteristic of the lipid profile under basal conditions on fasting and after an oral
lipid load and experience with influencing dysliopoproteinaemia by fenofibrates and atorvastatin).
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