**1. Introduction**

348 Progress in Hemodialysis – From Emergent Biotechnology to Clinical Practice

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30

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### **1.1 Kidney disease and cardiovascular mortality**

Cardiovascular disease is a leading case of mortality not only in the whole population but also in groups with different, noncardiovascular chronic conditions. Kidney disease is one of these and many patients with kidney disease paradoxically do not die from end stage kidney failure but from cardiovascular causes. Already mild or moderate renal impairment represents a considerable excess risk of cardiovascular mortality. The probability of premature death is even more striking in some subgroups of kidney patients – e.g. the cardiovascular mortality rate of young end stage renal disease (ESRD) patients is 500 times higher as compared with an age-matched control group. The situation is moreover complicated by the fact that traditional risk factors (the "Framingham factors") are of lesser predictive value in kidney disease than in general population (Foley et al, 1998, Magnus and Beaglehole, 2001, Go et al, 2004).

To explain this dismal picture it is not sufficient to disclose that chronic kidney disease (CKD) and chronic renal insufficiency (CRI) is associated with accelerated atherosclerosis and abnormal lipid/lipoprotein metabolism (Felström et al., 2003, Lacquaniti, 2010). One should keep in mind that "CKD", "CRI" and "ESRD" are collective terms and the actual diseases and conditions behind them are manifold (Table 1). Some of them (e.g. diabetes mellitus and hypertension) have a profound effect on lipid metabolism and atherosclerosis independently from kidney function already before the manifestation of renal impairment. From the data in Table 1 is evident that diabetes and hypertension is behind ESRD in one quarter (Great Britain) or even two thirds (USA) of cases.

The natural history of each underlying disease is dependent on a wide range of factors and although the K/DOQI classification based on glomerulal filtration rate is a very useful one from practical point of view it does not reveal anything about the pathogenesis of the particular condition.

Lipid and Lipoprotein Abnormalities in Chronic Renal Insufficiency: Review 351

3. Give simple advice how to assess cardiovascular risk in CRI, ESRD and HD patients in

Therapeutic attempts and possibilities to normalize the lipid abnormalities and decrease the high risk of cardiovascular events in CRI, ESRD and HD patients are not the topics of this

> **IMPAIRMENT OF KIDNEY FUNCTION**

**ABNORMAL LIPID STATUS ALTERED APOPROTEINS DECREASED LIPOPROTEIN CATABOLISM**

**ENDOTHELIAL DYSFUNCTION ACCELERATED ATHEROSCLEROSIS CARDIOVASCULAR MORTALITY**

Fig. 1. Factors responsible for abnormal lipid metabolism and accelerated atherosclerosis in

The changes of two basic lipid parameters – the concentration of triglycerides (TG) and total cholesterol (TC) in different forms of renal disease are in Table 3. Increased triglyceride concentration is a general feature of kidney disease whereas increased cholesterol is not. Assesment the risk of atherosclerosis related morbidity from these two parameters is of course not possible because they do not reflect the real metabolic situation sufficiently. Lipids are insoluble in blood plasma and therefore they can circulate only in the form of lipoproteins. On the other side increased TG alone is an important warning sign of the presence of highly

OTHER DISEASES, PATHOLOGICAL CONDITIONS

OXIDATIVE STRESS GLYCATION CARBAMYLATION

ALTERATIONS IN Ca AND P METABOLISM

1. Describe and analyze the lipid and lipoprotein abnormalities in CRI, ESRD and HD. 2. Show the results of a metaanalysis dealing with methodological problems measuring LDL-cholesterol in CRI, ESRD and HD patients and results from a study on analytical

quality of LDL-cholesterol assessment in real word laboratories.

**UREMIC TOXINS** GENETIC

kidney disease form a complicated and intertwined network

**2. Lipid and lipoprotein abnormalities in kidney disease** 

**2.1 Changes of routinely measured lipid parameters in CRI and HD** 

everyday clinical practice.

BACKGROUND ETHNICITY

INFLAMMATION IMMUNE DISORDER ANAEMIA PROTEIN LOSS

> TREATMENT DIALYSIS MODALITIES

chapter.


Table 1. Etiology of end stage renal disease in different regions of word. (According to Viklický, 2006)
