Lipid Disorders and Their Relevance to Outcomes in Chronic Kidney Disease

Cardiovascular disease is the major cause of death in patients with chronic kidney disease (CKD). Cardiovascular disease and many other complications of CKD are mediated by oxidative stress, inflammation, and dyslipidemia. This review provides a concise overview of the nature and mechanisms of CKD-induced lipid disorders and their adverse consequences. Lipid abnormalities in end-stage renal disease are characterized by: (a) reduced serum apoA-1 and high-density lipoprotein (HDL) concentrations, impaired HDL maturation and defective HDL antioxidant, anti-inflammatory and reverse cholesterol transport properties; (b) impaired clearance of very low-density lipoprotein and chylomicrons by the muscle and adipose tissue and of their remnants by the liver leading to hypertriglyceridemia, accumulation of intermediate-density lipoprotein and chylomicron remnants, and (c) oxidative modification of LDL and lipoprotein remnants favored by their structural abnormalities, oxidative stress, and impaired HDL antioxidant activity. Together these abnormalities result in: (a) uptake of oxidized LDL and remnant particles by macrophages and resident cells in the arPublished online: January 10, 2011 N.D. Vaziri, MD, MACP University of California, Irvine Medical Center Division of Nephrology and Hypertension The City Tower, 4th f loor, Orange CA 92868 (USA) Tel. +1 714 456 5142, Fax +1 714 456 6034, E-Mail ndvaziri @ uci.edu © 2011 S. Karger AG, Basel 0253–5068/11/0313–0189$38.00/0 Accessible online at: www.karger.com/bpu D ow nl oa de d by : 54 .7 0. 40 .1 1 12 /1 4/ 20 17 1 1: 11 :3 7 P M