Key result
Chronic hemodialysis is linked to ~20% lower fractional cholesterol absorption versus healthy controls.
Why the study?
Does cholesterol metabolism (absorption and synthesis) differ in patients on chronic hemodialysis compared to healthy controls?
Case-Control (n=24)
Does cholesterol metabolism (absorption and synthesis) differ in patients on chronic hemodialysis compared to healthy controls?
Absolute Event Rate: 42.8% vs 53.4%
p-value: p=<0.035
Patients on chronic hemodialysis exhibit reduced intestinal cholesterol absorption and hepatic cholesterol synthesis, suggesting that bile acid binding resins might be preferable to statins or ezetimibe for managing their cardiovascular risk.
Premature atherosclerosis is a major concern in patients on chronic dialysis and the identification of risk factors is important for preventive and interventional strategies. Other than the recognized atherogenic lipoprotein levels, little is known about overall cholesterol metabolism in patients on chronic hemodialysis (HD) and the best therapeutic intervention is still being debated. Therefore, we investigated intestinal cholesterol absorption, cholesterol and bile acid synthesis, and non-cholesterol plasma sterols in eight patients on dialysis and compared the results to those of 16 healthy male controls matched for body mass index and dietary cholesterol intake. Total, lowdensity lipoprotein (LDL) cholesterol, and triglycerides did not differ between the groups, but dialysis patients had a significantly lower high-density lipoprotein (HDL) cholesterol level (39 ± 11 mg/dL vs. 48 ± 10 mg/dL, p<0.045). However, fractional cholesterol absorption, was significantly lower in dialysis patients (42.8 ± 10.9% vs. 53.4 ± 11%, p<0.035), whereas plasma plant sterol concentrations and their ratios to cholesterol did not differ. Bile acid and total cholesterol synthesis were lower in dialysis patients (-40% and -25%, respectively), although the differences were not significant. In contrast, lathosterol and its ratio to cholesterol in plasma was significantly lower in dialysis patients (0.176 ± 0.084 mg/dL vs. 0.251 ± 0.102 mg/dL, p<0.024 and 0.733 ± 0.353 μg/mg vs. 1.172 ± 0.407 μg/mg, p<0.017, respectively), indicating reduced hepatic de novo cholesterol synthesis. It is concluded that reduced HDL cholesterol and reduced bile acid synthesis contributes to atherosclerosis pathogenesis in dialysis patients, whereas intestinal cholesterol absorption and hepatic cholesterol synthesis did not seem dominant in this process at this stage of disease. Consequently, treatment with bile acid binding resins could be preferable to treatment with cholesterol absorption and synthesis inhibitors.
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Igel-Korcagova et al. (2003) conducted a case-control in Chronic renal failure on hemodialysis (n=24). Chronic hemodialysis vs. Healthy male controls was evaluated on Fractional cholesterol absorption (p=<0.035). Patients on chronic hemodialysis had significantly lower fractional cholesterol absorption (42.8% vs 53.4%, p<0.035) and HDL cholesterol compared to healthy matched controls.
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