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Objective Oyslipidemia possibly contributes to the vascular complications commonly afflicting uremic patients. Lipoprotein (a) [Lp(a)] has been identified as an independent risk factor for atherosclerotic vascular dis ease. The aim of our study was to compare lipidparameters, including Lp(a), between hemodialysis (HO) and continuous ambulatory peritoneal dialysis (CAPO) patients. Design A cross-sectional study. Setting University Medical Center. Participants Forty CAPO and 40 HO patients carefully matched for age, sex, body mass index (BMI), smoking habits, and duration of dialysis were studied. A group of 40 healthy individuals matched for age, sex, BMI, and smoking habits was used as control. Interventions None. Main Outcome Measures Serum lipid parameters and atherogenic risk ratios were the main outcome measures. Results Both groups of dialysis patients had increased serum triglycerides and decreased levels of Apo AI and HOL cholesterol compared to controls. Moreover, the risk ratios total cholesterol/HOL cholesterol and LOL cholesterol/HOL cholesterol were significantly higher, and the ratio ApoA1/ApoB was significantly lower in both groups of patients in comparison to the normal subjects. Both groups of dialysis patients exhibited decreased ratios of LOL cholesterol/ApoB and HOL cholesterol/ApoAI, suggesting the presence of compositional lipoprotein changes. CAPO patients had a more atherogenic lipid profile compared to HO patients, since they exhibited higher levels of total and LOL cholesterol, of ApoB as well as of the ratios total cholesterol/HOL cholesterol and LOL cholesterol/ HOL cholesterol, and lower levels of the ratio ApoA1/ApoB compared to HO patients. Both groups of dialysis patients had increased serum Lp(a) levels. Even though CAPO patients had higher serum Lp(a) levels than HO patients, the differences between these two groups were only marginally statistically significant (p = 0.056 by Mann-Whitney U-test). Uremic dyslipidemia was positively correlated with serum albumin levels in both groups of patients. Conclusion CAPO patients exhibit a more atherogenic lipid profile than that of HO patients. The marked disturbances in Lp(a) levels may further increase the vascular risk in both groups of patients.

It has been reported that cumulative carnitine losses through dialysis membranes may worsen hyperlipidemia during long-term hemodialysis. However, carnitine supplementation has not shown a consistent beneficial response. We undertook the present study to determine if there is any hypolipidemic effect of L-carnitine on Greek dialysis patients in concert with the dialysate buffer composition (acetate or bicarbonate). A total of 28 patients (16 male, 12 female), mean age 43 years (range 21–61), with end-stage renal disease on maintenance hemodialysis for a mean period of 25 months (range 7–84) were studied. The dialysis schedule was 4 h, 3 times/week using cuprophane hollow-fiber dialyzers and acetate (n = 14) or bicarbonate (n = 14) dialysate. In all patients L-carnitine (5 mg/kg body weight) was infused intravenously 3 times/week at the end of each hemodialysis session. Blood samples for carnitine and lipid determinations were obtained before treatment, and 3 and 6 months following treatment. Even though L-carnitine did not modify most of the serum lipid levels, a significant decrease in serum triglycerides was evident in the whole group of patients (from 225 ± 76 to 201 ± 75 mg/dl, p = 0.03). Furthermore, L-carnitine could decrease serum triglycerides only in hypertriglyceridemic patients (from 260 ± 64 to 226 ± 82 mg/dl, p < 0.05). L-Carnitine resulted in a reduction of serum triglycerides in both patients on bicarbonate and on acetate dialysis, while there were no significant differences in the changes of lipid parameters after L-carnitine between the two groups of hemodialysis patients. We conclude that relatively low doses of L-carnitine supplementation could contribute to the management of some hypertriglyceridemic hemodialysis patients.