Hyperlipidemia in Children with Chronic Renal Insufficiency

Abstract

SummaryTotal serum cholesterol, phospholipids, and triglyceride levels, lipoprotein fractionation, and plasma parathormone levels were measured in a group of 31 nonnephrotic children with various levels of renal function and on hemodialysis. Group A served as controls and consisted of eight healthy children with glomerular fdtration rate (GFR) greater than 110 ml/min/1.73 m2. Group B consisted of six children with GFR of 60 to 95 ml/min/1.73 m2. Group C consisted of nine children with GFR of 10 to 40 ml/min/ 1.73 m2, and group D consisted of eight children on maintenance hemodialysis with GFR of 0 to 5 ml/min/1.73 m2. Among the groups, there were no significant differences in total serum cholesterol and phospholipid levels. A significant ( P < 0.05) increase in triglyceride levels was observed in patient groups C and D.Lipoprotein fractionation revealed a significant increase (P < 0.05) in the pre-beta lipoprotein levels (very low density lipoproteins) in patients in group D with 63% of these patients demonstrating a type IV lipoprotein pattern. There were no significant differences observed in the beta lipoproteins (low-density lipoproteins). However, the alpha lipoproteins (high-density lipoproteins) decreased significantly ( P < 0.05) in patients whose GFR was below 40 ml/min/1.73 m2 (group C) as well as patients in group D.Absolute plasma parathormone levels did not significantly correlate with serum triglyceride levels and remained normal until after the onset of hemodialysis when they increased significantly in all patients. SpeculationEvidence has been accumulating over the past few years that chronic hemodialysis and renal transplant adult patients have shortened survival because of accelerated atherosclerotic cardiovascular disease for which hyperlipidemia could be one of several etiologic factors. Similar epidemiologic studies have not been performed in children. We have demonstrated for the first time in children that alterations in serum triglycerides and alpha lipoproteins (high-density lipoproteins) occur early in chronic renal insufficiency and before the onset of uremia when the glomerular fdtration rate falls below 40 ml/min/1.73 m2. These lipid abnormalities become further aggravated with the onset of hemodialysis. If pediatric renal transplant patients show similar lipid abnormalities, then the potential for cardiovascular complications will be of importance in the early medical management of these children.

Lipid Profiles and Lipase Activities in Children and Adolescents with Chronic Renal Failure Treated Conservatively or with Hemodialysis or Transplantation

“…Similarly, those with severe renal failure had low LPL and HTGL activities. The hypertrig1yceridemia and the decreased HDL-C level in CRF reported in this study confirm the results of previous studies in children (20) and adults (16). The inverse correlation between serum TG and HDL-C levels in our patients was in keeping with the view that low HDL-C levels in hypertriglyceridemic states are the result of reduced TG metabolism (18).…”

“…It has been reported both in adults (19) and children (20) that the hypertriglyceridemia occurs early in the course of renal insufficiency. In the present study, hypertriglyceridemia was observed even in patients with mild renal failure who had normal lipase activities.…”

Further Definition of Lipid-Lipoprotein Abnormalities in Children with Various Degrees of Chronic Renal Insufficiency

“…The results of this study confirm previous reports that hypertriglyceridemia, Frederickson type IV, and low HDL-CH levels represent the most common dyslipidemic disorders in uremic children (1,5) as well as in uremic adults (2,4).…”

“…Hypertriglyceridemia, Frederickson type IV, associated with a consistent decrease in HDL-CH levels, represents the most common dyslipoproteinaemic disorder in these patients (1)(2)(3)(4)(5). Another unusual lipoprotein abnormality in uremic adults consists of an additional slow migrating pre-/3 VLDL band on AGE with an intermediate position between the regular fast-moving pre-/3 and /3…”

Etiology and management of dyslipidemia in children with chronic kidney disease and end-stage renal disease

“…While some of the abnormalities in these indices may recede after renal transplantation, others may persist [6]. In addition, serum TC levels are near normal, while LDL-C levels are variable [7][8][9][10][11][12][13][14]. …”