Increased lipoprotein-remnant formation in chronic renal failure.

Since accelerated atherosclerosis may be induced by excess circulating remnants of triglyceride-rich lipoprotein catabolism, we looked for evidence of remnant particle accumulation in the lipoproteins of 11 patients on long-term dialysis. We found several abnormalities in lipoprotein protein and lipids: enrichment of intermediate-density lipoproteins (ILD) and low-density lipoproteins (LDL) with triglyceride; the presence of apoprotein B48 (a "marker" for intestinal lipoproteins) in very-low-density lipoproteins (VLDL); an increased concentration of apoprotein AIV (a protein related to chylomicron transport); the presence of AIV in VLDL, IDL, and LDL; and the presence in LDL of apoproteins C and E (proteins not normally found in LDL). These findings strongly suggest accumulation of remnants of triglyceride-rich lipoproteins in patients with chronic renal failure who are undergoing peritoneal dialysis or hemodialysis, and may explain in part the increased incidence of coronary deaths among these patients.