Coronary risk factors in maintenance hemodialysis patients: Who is the culprit – hemodialysis or chronic renal failure?

OBJECTIVE: Dyslipidemia, common in uremic patients subjected to maintenance hemodialysis (HD), represents an independent risk factor for atherosclerosis; but the association between long-term HD and uremic dyslipidemia is not crystal clear. The present study was aimed to ascertain any association. MATERIALS AND METHODS: The effects of chronic renal failure (CRF) and HD duration on serum lipids, lipoproteins and homocysteine (HC) were studied in 84 patients suffering from CRF subjected to maintenance HD and were compared with 68 healthy, age-, sex- and race-matched control cohorts. RESULTS: Increase in serum free cholesterol (FC), triglycerides, very low-density lipoprotein cholesterol and HC levels, and decrease in esterified cholesterol (EC), EC/FC ratio, high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol levels were highly significant (P < 0.001) in pre-dialysis patients compared to controls. Further disturbances were observed (P < 0.05) by repeated HD, resulting in further significant increase in FC, and decrease in EC/FC ratio and HDL-C levels after 40 dialysis schedules. CONCLUSION: Levels of HDL-C, plasma FC, and ratio of EC/FC appeared to be clearly altered by HD duration, submitting patients to a greater risk of atherosclerosis due to maintenance HD.