Korean Journal of Nephrology 1998;17(5):735-745.

만성 신부전 환자에서의 혈청지질과 지단백질 (Serum Lipids and Lipoproteins in Patients with Chronic Renal Failure)

정택균, 김현수, 나명윤, 정균호, 정권, 이성철, 김수완, 김남호, 최기철, 정익주, 김형준, 바종춘, 정민영, 강정채, 이태희, 강영준 (Taek Kyun Jeong, Hyun Soo Kim, Myong Yun Nah, Gyun Ho Jeong, Kwon Jung, Seong Cheol Lee, Soo Wan Kim, Nam Ho Kim, Ki Chul Choi, I

Abstract

We measured serum lipoprotein(a) [Lp(a)] concentrations in 304 uremic patients treated on predialysis, hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD), and compared them with those in 43 normal controls. The mean values were 46.1mg/dl in predialysis, 35.7mg/dl in HD, 54.7mg/dl in CAPD patients and 17.0mg/dl in controls, respectively. Serum Lp(a) levels were elevated both in the predialysis patients (P<0.001) and in the CAPD patients (P<0.001) compared with those in controls, and were also elevated in the CAPD patients (P<0.01) compared with HD patients. Serum Lp (a) levels tended to be higher in HD patients compared with controls, although these differences did not reach statistical significance. We observed statistically significant positive correlations of Lp(a) to serum levels of total cholesterol (TC) (r=0.279, P<0.01), LDL-cholesterol (r=0.335, P<0.01), and Apo(B) (r=0.352, P<0.01), and significant negative correlation of Lp(a) to serum level of albumin (r=-0.278, P<0.01) in 304 CRF patients. CAPD patients had a more atherogenic lipoprotein profile than did HD patients: besides significantly higher Lp(a) levels (P<0.01), total (P<0.001) and LDL (P<0.001) cholesterol, triglycerides (P<0.05), and apo (B)(P<0.001) were significantly elevated in comparison to HD patients. The marked elevation of serum Lp(a) in patients on CAPD may be due to increased hepatic synthesis as a consequence of the substantial amounts of plasma proteins lost in the dialysate. The increased serum concentrations of Lp(a) may contribute to the high risk for atherosclerosis in end stage renal disease, especially in patients treated by CAPD.