The Uremic Dyslipoproteinemia: Its Characteristics and Relations to Clinical Factors

Abstract

ABSTRACT. Fasting concentrations of cholesterol and triglycerides were determined in total serum and in serum fractions of very low (VLDL), low (LDL) and high (HDL) density lipoproteins in 141 patients with chronic renal failure (CRF) of different etiologies. They were grouped according to sex and degree of renal failure. The characteristic dyslipoproteinemia of uremia, viz. hypertriglyceridemia, raised VLDL and low HDL, cholesterol enrichment of VLDL and triglyceride enrichment of LDL, was present already in the mildest, asymptomatic group (creatinine 140–400 μmol/l), highly significant for men (n=28) but not statistically significant for women (n=7). There was a negative correlation between creatinine and LDL cholesterol concentrations and between creatinine and the cholesterol/triglyceride ratio in LDL in males, otherwise the degree of renal insufficiency did not influence the dyslipoproteinemia. Neither different etiologies of CRF, nor treatment with β‐adrenergic blocking agents or thiazides did seem to influence lipoprotein levels orderly. Males on antacids had lower serum and LDL cholesterol levels, which is probably explained by the negative relation between LDL cholesterol and creatinine, as antacids are more often administered in advanced uremia. Males treated with protein‐poor diet differed from other groups by not having elevated VLDL triglycerides. It is concluded that the lipoprotein abnormalities found in uremia are present already at an early stage of renal impairment and, except for LDL cholesterol in males, fairly uninfluenced by the degree of renal function and etiology of the disease. It is suggested that the dyslipoproteinemia of CRF is caused by effects on several mechanisms in lipoprotein metabolism, e.g. deficiency of different apolipoproteins.

Genetic and Environmental Determinants for Lipoprotein Concentrations in Blood

“…Serum lipoproteins were separated by an ultracentrifugal spin at d = 1.006 kg/l followed by precipitation of apoliprotein B containing lipoproteins with heparin MnC12. The concentrations of cholesterol and triglycerides were determined in the isolated VLDL and HDL fractions, and calculated in the LDL fraction as (LDL+HDL)-HDL as described in detail earlier (8). Agarose gel lipoprotein electrophoresis was performed on whole serum as well as on the top and bottom fractions obtained after ultracentrifugation.…”

“…In addition, most of the evidence came from only one family in which the mother had diabetic glomerulonephritis and was treated with hemodialysis. Uremia is known to cause derangements of lipoprotein metabolism (8) and therefore it could be assumed that uremia in the mother, rather than a major gene, explains the finding.…”

Fatty Acid Composition of Serum and Adipose Tissue Lipids in Males with Chronic Renal Failure

“…Seventy-two males with CRF were investigated. They are derived from the male group (n=89) of patients whose lipoproteins have been reported in a previous study (24). The increased serum creatinine had in all cases been known for at least one year.…”

“…Patients with chronic non-nephrotic renal failure (CRF) often have hypertriglyceridemia (HTG) but normal or low serum cholesterol concentrations (5,24,25). Triglycerides (TG) and cholesterol in very low density lipoproteins (VLDL), like TG in the low density lipoprotein (LDL) fraction (25), are usu-ally high.…”

“…Triglycerides (TG) and cholesterol in very low density lipoproteins (VLDL), like TG in the low density lipoprotein (LDL) fraction (25), are usu-ally high. In high density lipoproteins (HDL), cholesterol is often low (24). At least in males, LDL cholesterol decreases with the severity of the disease (24).…”