Changes in serum total and lipoprotein fraction triglyceride and cholesterol levels were studied in 24 adults on home haemodialysis. Half the patients were randomly allocated to a low cholesterol (mean 200 mg/day), fat-modified diet (mean polyunsaturated/saturated fat ratio of 1.0 with a mean of 43% of the total energy content derived from fat). 2. Before dietary manipulation, triglyceride levels in all lipoprotein fractions were significantly higher (P less than 0.02) than in a control group of age and sex matched normal subjects. Total cholesterol, very-low-density-lipoprotein (VLDL) and low-density-lipoprotein (LDL) cholesterol were also significantly raised (P less than 0.02), but high-density-lipoprotein (HDL) cholesterol was normal. In the patients on a fat-modified diet triglyceride levels did not alter in any of the lipoprotein fractions. Total cholesterol and LDL cholesterol levels fell significantly into the normal range (P less than 0.002 and less tha 0.001 respectively) but VLDL and HDL cholesterol levels did not change. 3. Hypertriglyceridaemia is the most common lipid abnormality in patients with renal failure and a long-term fat-modified diet is, therefore, of limited therapeutic importance in these patients unless there is a low HDL/LDL cholesterol ratio.
