Cardiovascular, cerebrovascular and peripheral vascular development are the largest cause-specific reason for morbidity and mortality in
end-stage renal disease (
ESRD) patients. The high prevalence of cardio- and cerebrovascular death may be explained by multiple factors present in patients with progressive renal disease, including
hypertension,
hyperlipidemia,
hyperhomocysteinemia,
diabetes mellitus, and
hyperparathyroidism. Experimental studies have provided in vivo and in vitro data to support the notion that
lipid abnormalities contribute to glomerular and interstitial injury of the renal parenchyma. Hyperchlolesterolemia and increased
low-density lipoprotein (
LDL) cholesterol are prevalent in patients with the
nephrotic syndrome. Plasma
high-density lipoprotein (
HDL) cholesterol is decreased, and reverse
cholesterol transport is impaired in
hemodialysis (HD) and pre-
ESRD patients.
Chronic renal failure patients treated with HD have an increased prevalence of
intermediate-density lipoprotein (IDL), and
lipoprotein(a). The findings in diabetic patients corresponded with those in nondiabetic patients with
renal failure, but diabetic patients have higher apoliprotein C-III and apoliprotein E concentrations. Impaired lipid metabolism is common in patients receiving
peritoneal dialysis (PD). In most
ESRD patients treated with
peritoneal dialysis hypercholesterolemia and hyperglyceridemia are found. Wide panels of therapeutic interventions aimed at correcting the
lipid abnormalities that may develop in chronic renal patients as well as in
ESRD patients are currently available. Although some novel pharmacological agents are remarkably effective in returning the
lipid abnormalities to normal, there is still no convincing evidence based on long-term prospective studies, that would clearly demonstrate a significant reduction of cardiovascular morbidity and mortality of
ESRD patients. The therapeutic approaches, which may be considered, include mainly dietary and life-style modifications, selective use of some technical components of dialysis systems, and the judicious prescriptions of
lipid-lowering drugs.