Effect of long-term hemodialysis on plasma lecithin: cholesterol acyltransferase activity and the amounts and compositions of HDL2 and HDL3 in hemodialysis-treated patients with chronic renal failure: a 9-year longitudinal study.

BACKGROUND: Atherosclerosis was correlated with hemodialysis duration (HD) in chronic renal failure (CRF) patients. Dyslipidemias were identified as atherogenic risk factors. MATERIAL/
METHODS: To investigate variations in HDL2 and HDL3 composition and lecithin: cholesterol acyltransferase (LCAT) activity as functions of HD, 20 CRF patients were selected for maintenance hemodialysis during the 9 years from April 1, 1991 to March 31, 2000. Blood samples were drawn four times: 1991 (T0, study begin), 1994 (T1), 1997 (T2), and 2000 (T3). T0 results were taken as references.
RESULTS: Triacylglycerol concentrations were 1.12-fold higher at T1 (P<0.01), 1.31-fold at T2, and 1.63-fold at T3 (P<0.001). Increases of 14% and 33% of total cholesterol were noted at T2 (P<0.05) and T3 (P<0.001). Hypertriglyceridemia correlated with HD (r=0.70, P<0.05). LCAT activity decreased by 27%, 39%, and 51% at times T1, T2, and T3, respectively, this activity being negligible in 30% of patients at T2 and 40% at T3. An inverse relationship was noted between LCAT activity and HD (r=-0.80, P<0.001). Increases in HDL2-unesterified cholesterol (UC) and HDL3-UC were obtained at T2 and T3 (P<0.05), and high HDL2-triacylglycerols (TG) and HDL3-TG were noted at T1, T2, and T3 (P<0.001). HDL3-phospholipids (PL) values were diminished by 9% at T1 (P<0.05), 17% at T2, and 19% at T3 (P<0.001).
CONCLUSIONS: Long-term hemodialysis aggravates lipid anomalies following CRF. Alterations in HDL composition contribute to the reduced efficacy of reverse cholesterol transport and patients are submitted to a greater risk for atherosclerosis.