Effect of lifestyle changes and atorvastatin administration on dyslipidemia in hemodialysis patients: a prospective study.

INTRODUCTION Atherogenic dyslipidemia accelerates the development of cardiovascular complications and contributes to mortality of hemodialysis (HD) patients. OBJECTIVES The aim of the study was to evaluate the effects of lifestyle changes followed by treatment with atorvastatin in dyslipidemic HD patients. PATIENTS AND METHODS Dyslipidemic HD patients (n = 49) were enrolled into the prospective study. Forty-two patients completed a 21-week lifestyle intervention. In 34 patients, who continued to be dyslipidemic, atorvastatin was used for 14 weeks. After 4 weeks, the initial dose of atorvastatin of 10 mg/d was increased to 20 mg/d in dyslipidemic patients. RESULTS The most pronounced effects of lifestyle changes were shown at 14 weeks and included significant differences in high-density lipoprotein cholesterol, low-density lipoprotein (LDL) cholesterol, salusin α, malondialdehyde-oxidized LDL, fructosamine, and monocyte CD36 expression. Immunoglobulin G anti-oxLDL showed the highest values at 21 weeks. Seven patients (16.7%) were nondyslipidemic at 21 weeks. In patients who continued to be dyslipidemic, LDL cholesterol and triglyceride levels significantly decreased, salusin α levels and CD36 expression increased, and dyslipidemia resolved in 59.4% of the patients following atorvastatin treatment. CONCLUSIONS Lifestyle changes have selective efficacy in the treatment of dyslipidemia in HD patients, while atorvastatin (up to 20 mg/d) may be effective in about 60% of nonresponders to lifestyle changes. Lipid-lowering interventions affect plasma salusin α and monocyte CD36 expression.