Dyslipidemia is a common feature of various renal diseases. This perturbed lipid metabolism results in accelerated atherosclerosis and increased cardiovascular morbidity and mortality. Treatment of dyslipidemia, in addition to normalization of blood pressure and reduction of proteinuria, could provide additional means to retard the progression of chronic renal insufficiency. Possible therapeutic approaches include mainly dietary and life-style modifications, selective use of some technical components of dialysis systems, and the judicious prescriptions of lipid-lowering drugs. Even with relatively normal lipid and lipoprotein profiles statin therapy seems to prevent atherogenesis acceleration. A wide range of therapeutic interventions, targeting the lipid abnormalities that may develop in chronic renal patients and end-stage renal disease (ESRD) are currently available, though still without convincing evidence based on long-term prospective studies which clearly demonstrate a significant reduction in cardiovascular morbidity and mortality of ESRD patients. However, extensive investigations, concerning the best long-term therapeutic strategy for this high-risk population of patients, are still missing.
American Heart Association Councils on Kidney in Cardiovascular Disease, High Blood Pressure Research, Clinical Cardiology, and Epidemiology and Prevention.Kidney disease as a risk factor for development of cardiovascular disease: a statement from the American Heart Association Councils on Kidney in Cardiovascular Disease, High Blood Pressure Research, Clinical Cardiology, and Epidemiology and Prevention. Circulation2003; 108: 2154–69.
2.
MannJ.F., GersteinH.C., Dulau-FloreaI., LonnE.Cardiovascular risk in patients with mild renal insufficiency. Kidney Int2003; 63(suppl 84): S192–6.
3.
WheelerD.C., TownendJ.N., LandrayM.Y.Cardiovascular risk factors in predialysis patients: baseline data from the Chronic Renal Impairment in Birmingham (CRIB) study. Kidney Int2003; 63(suppl 84): S201–3.
4.
MassyZ.A., KhoaT.N., LacourB., Descamps-LatschaB., Khoa ManN., JingersP.Dyslipidemia and the progression of renal disease in chronic renal failure patients. Nephrol Dial Transplant1999; 14: 2392–7.
5.
FoleyR.N., ParfreyP.S., SarnakM.J.Clinical epidemiology of cardiovascular disease in chronic renal disease. Am J Kidney Dis1998; 32(suppl): S112–9.
LowrieE.G., LewN.L.Death risk in hemodialysis patients: the predictive value of commonly measured variables and an evaluation of death rate differences between facilities. Am J Kidney Dis1990; 15: 458–82.
8.
RossR.Atherosclerosis-an inflammatory disease. N Engl J Med1999; 340: 115–26.
9.
RattazziM., PuatoM., FagginE., BertipagliaB., GregoF., PaulettoaP.New markers of atherosclerosis in end-stage renal disease. J Nephrol2003; 16: 11–20.
10.
AriciM., WallsJ.End-stage renal disease, atherosclerosis, and cardiovascular mortality: Is C-reactive protein the missing link?Kidney Int2001; 59: 407–14.
11.
StenvinkelP., HeimburgerO., PaultreF., DiczfalusyU., WangT., BerglundL., JogestrandT.Strong association between malnutrition, inflammation, and atherosclerosis in chronic renal failure. Kidney Int1999; 55: 1899–911.
12.
PanichiV., MiglioriM., De PietroS.C-reactive protein in patients with chronic renal diseases. Ren Fail2001; 23: 551–62.
13.
KaysenG.A.Hyperlipidemia of chronic renal failure. Blood Purif1994; 12: 60–7.
14.
TakenakaT., TakahashiK., KobayashiT., OshimaE., IwasakiS., SuzukiH.Oxidized low density lipoprotein (Ox-LDL) as a marker of atherosclerosis in hemodialysis (HD) patients. Clin Nephrol2002; 58: 33–7.
15.
TsumuraM., KinouchiT., OnoS., NakajimaT., KomodaT.Serum lipid metabolism abnormalities and change in lipoprotein contents in patients with advanced-stage renal disease. Clin Chim Acta2001; 314: 27–37.
16.
KronenbergF., UtermannG., DieplingerH.Lipoprotein(a) in renal disease. Am J Kidney Dis1996; 27: 1–25.
ShojiT., NishizawaY., KawagishiT.Atherogenic lipoprotein changes in the absence of hyperlipidemia in patients with chronic renal failure treated by hemodiialysis. Atherosclerosis1997; 131: 229–36.
19.
MoberlyJ.B., AttmanP.O., SamuelssonO.Alteration in lipoprotein composition in peritoneal dialysis patients. Perit Dial Int2000; 22: 1–9.
20.
JohanssonA.C., SamuelssonO., AttmanP.O.Dyslipidemia in peritoneal dialysis-relation to dialytic variables. Perit Dial Int2000; 20: 306–14.
21.
KronenbergF., LingenhelA., NeyerU.Prevalence of dyslipidemic risk factors in hemodialysis and CAPD patients. Kidney Int2003; 63(suppl 84): S113–6.
Executive Summary of the Third Report of the National Cholesterol Education Program(NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA2001; 285: 2486–97.
24.
MerkusM.P., JagerK.J., DekkerF.W., de HaanR.J., BoeschotenE.W., KredietR.T.Predictors of poor outcome in chronic dialysis patients: The Netherlands Cooperative Study on the Adequacy of Dialysis. The NECOSAD Study Group. Am J Kidney Dis2000; 35: 69–79.
25.
JohansenK.L., ShuberTt, DoyleJ., SoherB., SakkasG.K., Kent-BraunJ.Z.Muscle atrophy in patients receiving hemodialysis: Effects on muscle strength, muscle quality, and physical function. Kidney Int2003; 63: 291–7.
26.
PainterP.Exercise for patients with chronic disease: physician responsibility. Curr Sports Med Rep2003; 2: 173–80.
27.
AzarR., DequiedtF., AwadaJ.Effects of fish oil rich in polyunsaturated fatty acicds on hyperfipidemia of hemodialysis patients. Kidney Int1989; 36(suppl): S239–42.
28.
BruntonC., VargheseZ., MoorheadJ.F.Lipopheresis in the nephrotic syndrome. Kidney Int1999; 71(suppl): S6–9.
DiopM.E., VironB., BailleulS.Lp(a) is increased in hemodialysis patients according to the type of dialysis membrane: A 2-year follow-up study. Clin Nephrol2000; 54: 210–7.
31.
SperschneiderH., DeppischR., BeckW., WolfH., SteinG.Impact of membrane choice and blood flow pattern on coagulation and heparin requirement-potential consequences on lipid concentrations. Nephrol Dial Transplant1997; 12: 2638–46.
32.
de PrecigoutV., HigeuretD., LarroumetN.Improvement in lipid profiles and triglyceride removal in patients on polyamide membrane hemodialysis. Blood Purif1996; 14: 170–6.
33.
BlankestijnP.J., VosP.F., RabelinkT.J., van RijnH.J., JansenH., KoomansH.A.J Am Soc Nephrol1995; 5: 1703–8.
34.
SeresD.S., StrainG.W., HashimS.A., GoldbergI.J., LevinN.W.Improvement of plasma lipoprotein profiles during high-flux dialysis. J Am Soc Nephrol1993; 3: 1409–15.
35.
DocciD., CapponciniC., MengozziS., BladratiL., NeriL., FelettiC.Effects of different dialysis membranes on lipid and lipoprotein serum profiles in hemodialysis patients. Nephron1995; 69: 323–6.
36.
Merello GodinoJ.I., RenteroR., OrlandiniG., MarcelliD., RoncoC.Results from EuCLID (European Clinical Dialysis Database): Impact of shifting treatment modality. Int J Artif Organs2002; 25: 1049–60.
37.
MuneM., YukawaS., KishinoM.Effect of vitamin E on lipid metabolism and atherosclerosis in ESRD patients. Kidney Int1999; 71: S126–9.
38.
TsuruokaS., KawaguchiA., NishikiK.Vitamin E-bonded hemodialyzer improves neutrophil function and oxidative stress in patients with end-stage renal failure. Am J Kidney Dis2002; 39: 127–33.
39.
Bonnefont-RousselotD., LehmannE., JaudonM.C., DelattreJ., PerroneB., RechkeJ.P.Blood oxidative stress and lipoprotein oxidizability in hemodialysis patients: Effect of the use of a vitamin E-coated dialysis membrane. Nephrol Dial Transplant2000; 15: 2020–8.
40.
BredieS.J., BoschF.H., DemackerP.N., StalenhoefA.F., van LeusenR.Effects of peritoneal dialysis with an overnight icodextrin dwell on parameters of glucose and lipid metabolism. Perit Dial Int2001; 21: 275–81.
41.
BrulezH.F., van GuldenerC., DonkerA.J., ter WeeP.M.The impact of an aminoacid-based peritoneal dialysis fluid on plasma total homocystein levels, lipid profile and body fat mass. Nephrol Dial Transplant1999; 14: 154–9.
42.
ChertowG.M., BurkeS.K., RaggiP., for the Treat to Goal Working Group. Sevelamer attenuates the progression of aortic and coronary calcifications in hemodialysis patients. Kidney Int2002; 62: 245–52.
43.
ChertowG.M., BurkeS.K., DillonM.A., SlatopolskyE.Long-term effects of sevelamer hydrochloride on the calcium x phosphate product and lipid profile of hemodialysis patients. Nephrol Dial Tranplant1999; 14: 2907–14.
44.
PrataM.M., MadeiraC., VicenteO., MuguelM.J.Lipid profile in haemodialysis patients treated with recombinant human erythropoetin. Nephrol Dial Transplant1998; 13: 2345–7.
WannerC., KraneV.Non-high-density lipoprotein cholesterol: A target of lipid-lowering in dialysis patients. Am J Kidney Dis2003; 41(suppl): S72–5.
47.
van den AkkerJ.M., BredieS.J., DiepenveenS.H., van TitsL.J., StalenhoefA.F., van LeusenR.Atorvastatin and simvastatin in patients on hemodialysis: effects on lipoproteins, C-reactive protein and in vivo oxidized LDL. J Nephrol2003; 16: 238–44.
48.
SaltissiD., MorganC., RigbyR.J., WesthuyzenJ.Safety and efficacy of simvastatin in hypercholesterolemic patients undergoing chronic renal dialysis. Am J Kidney Dis2002; 39: 283–90.
49.
RidkerP.M., Nader RifaiM.P., ClearfieldM.Measurement of C-reactive protein for the targeting of statin therapy in the primary prevention of acute coronary events. N Engl J Med2001; 344: 1959–65.
50.
FarnierM., SalkoT., IsaacssohnJ.L., TroendleA.J., DejagerS., GonasunL.Effects of baseline level of triglycerides on changes in lipid levels from combined fluvastatin+fibrate (bezafibrate, fenofibrate, or gemfibrozil). Am J Cardiol2003; 92: 794–7.
51.
MassyZ.A., MaJ.Z., LouisT.A., KasiskeB.L.Lipid lowering therapy in patients with renal disease. Kidney Int1995; 48: 188–98.
52.
CorsiniA., BellostaS., BaettaR., FumagalliR., PaolettiR., BerniniF.New insights into the parmacodynamic and pharmacokinetic properties of statins. Parmacol Ther1999; 84: 413–28.
53.
HarrisK.P.G., WheelerD.C., ChongC.C., the Atorvastatin in CAPD Study investigators: A placebo-controlled trial examining atorvastatin in dyslipidemic patients undergoing CAPD. Kidney Int2002; 61: 1469–74.
54.
Kris-EthertonP.M., HarrisW.S., AppelL.J., for the AHA Nutrition Committee: Omega-3 fatty acids and cardiovascular disease: New Recommendations from the American Heart Association. Arterioscler Thromb Vasc Biol2003; 23: 151–2.
55.
KhajehdehiP.Lipid-lowering effect of polyunsaturated fatty acids in hemodialysis patients. J Ren Nutr2000; 10: 191–5.
56.
BaigentC., LandryM.Study of Heart and Renal Protection (SHARP). Kidney Int2003; 63(suppl 84): S207–10.
