Abstract
Reducing LDL cholesterol concentrations is generally accepted as an effective tool for reducing cardiovascular mortality, however, in patients with renal failure undergoing a dialysis procedure, statin therapy is not as effective in reducing cardiovascular complications. Dialyzed patients usually have dyslipidemia with elevated levels of VLDL and IDL cholesterol accompanied by lower concentrations of HDL cholesterol and increased levels of triacylglycerols (TAG).
Few studies have dealt with the distribution of cholesterol between individual lipoprotein classes under the conditions of the hemodialysis process, long-term effects of dialysis to lipid levels. Similarly, very little is known about cholesterol homeostasis under these conditions; in the available literature there are only a few works with different results.
In general, these work shows a reduced or unchanged level of lathosterol, a cholesterol biosynthesis marker, and elevated or unchanged concentrations of phytosterols as absorption markers. In addition, dialyzed individuals with higher levels of cholesterol absorption can expect higher mortality.
This effect is likely to be the backdrop of low efficacy of statin therapy in patients with terminal renal failure (ESRD) in AURORA or 4D studies. Limiting the absorption of cholesterol with ezetimibe in combination with statins, the risk of atherosclerotic events has been reduced in patients with chronic renal impairment (CKD), but not in the ESRD subgroup.