Alterations of Lipid Metabolism in Chronic Nephropathies: Mechanisms, Diagnosis and Treatment

Nephropathic subjects show an increased tendency to develop cardiovascular diseases, mainly as the consequence of several risk factors including increased oxidative stress, inflammation, physical inactivity, anemia, vascular calcification, and endothelial dysfunction. The alterations in lipid metabolism represent a relatively lesser important cause of genesis and progression of atherosclerosis. Unfortunately, in these patients the atherogenic potential of dyslipidemia may depend more on apolipoproteins than on lipid abnormalities, and may not always be recognized by measurement of plasma lipids alone. The aim of this review was therefore to analyze the main lipid alterations that can occur in nephropathic patients, as well as their causes and their effects on the cardiovascular system. The clinical evidence and recommendations for the use of lipid-regulating drugs in patients with chronic kidney disease, nephrotic syndrome, in patients undergoing hemoand peritoneal dialysis and in transplanted patients was also reviewed. Moreover, we analyzed the link between dyslipidemia and kidney disease onset and progression and the role of statins in preventing it. Copyright © 2010 S. Karger AG, Basel Published online: March 27, 2010 Prof. Michele Buemi Via Salita Villa Contino, 30 IT–98100 Messina (Italy) Tel. +39 090 221 2265, Fax +39 090 293 5162 E-Mail buemim @ unime.it © 2010 S. Karger AG, Basel 1420–4096/10/0332–0100$26.00/0 Accessible online at: www.karger.com/kbr D ow nl oa de d by : 54 .7 0. 40 .1 1 11 /1 9/ 20 17 8 :1 6: 18 A M Management of Dyslipidemia in Kidney Diseases Kidney Blood Press Res 2010;33:100–110 101 Moreover, we analyzed the link between dyslipidemia, kidney disease onset and progression, and the role of statins in preventing it. Chronic Kidney Disease CKD is associated with an early atherosclerotic process and with an increased cardiovascular morbidity and mortality [3] . Although the nature of dyslipidemia can be significantly influenced by several intrinsic (nephrotic proteinuria, concomitant diseases such as diabetes mellitus, hereditary disorders of lipid metabolism) or exogenous (erythropoietin, steroids, calcineurin inhibitors, etc.) factors, the most common quantitative lipid abnormalities in predialysis CKD patients are hypertriglyceridemia, reduced high-density lipoprotein (HDL) cholesterol levels as well as increased concentrations of lipoprotein(a) (Lp(a)) [4] . Total and LDL cholesterol levels are usually within normal limits or slightly reduced in these patients [5] . VLDL and Triglyceride Levels Hypertriglyceridemia is partially due to a downregulation of lipoprotein lipase (LPL), hepatic lipase, verylow-density lipoprotein (VLDL) and low-density lipoprotein receptor (LDL-r) expression ( fig. 1 ). Elevated VLDL cholesterol LPL Reduced activity