1979 Volume 6 Issue 4 Pages 439-444
Serum lipoproteins were investigated in 151 patients undergoing chronic hemodialysis for renal failure. Hyperlipoproteinemia (over 700mg/100ml) was demonstrated in 34 cases of them. According to the criteria of WHO, those were classified as follows: Type III, 12 cases; Type IIb, 8 cases; Type IV, 7 cases; Type IIa, 5 cases; Type V, 2 cases. With polyacrylamide-gel disc-electrophoresis, abnormal lipoprotein bands such as extra pre-beta, extra beta and mid bands were recognized in many cases of 151 patients.
It is well known that the metabolism of the circulating lipoproteins is mediated by some enzymes. The activities of the following enzymes were determined: Total postheparin lipolytic activities were decreased in all subjects, and protamine-inactivated as well as protamine-resistant lipase activities reduced in almost all of them. Lecithin cholesterol acyltransferase activities were markedly decreased in about one half of the subjects, more and more reduced by heparin infusions associated with the hemodialysis procedure.
Basal serum fatty acid concentrations were supra-normal in only 6 cases of 49 patients. By contrast, there were considerable increases of free fatty acid in all subjects during the hemodialysis procedure. Hypertriglyceridemia was demonstrated in 21 cases of 71 patients, and hypercholesterolemia was observed in 11 cases of 71 patients. Concentrations of serum lipid peroxide were increased in 33 of 105 subjects.
It is said that accelerated atherosclerosis is a major risk to long-term survivors on maintenance hemodialysis. Although the nature of the causal chain linking plsma lipids and lipoproteins to atherosclerosis is as yet unclear, clinical and experimental studies have provided evidences that the concentration of plasma beta, pre-beta lipoproteins and remnants play an essential role in atherogenesis. Therefore, we must consider therapeutic measures for eliminating hyperlipidemia as well as hyperlipoproteinemia (abnormal lipoproteinemia) in order to protect the patients with chronic renal failure from atherosclerosis and subsequent arteriosclerotic diseases.
