Lipoprotein heterogeneity in end-stage renal disease.

Fifteen patients on chronic maintenance hemodialysis without any additional known cause for dyslipidemia were arbitrarily divided into two groups based on fasting plasma triglyceride levels. The hypertriglyceridemic patients (plasma triglyceride levels above 170 mg/dl, N = 7) also had decreased high density lipoprotein (HDL) cholesterol levels and decreased post-heparin plasma lipoprotein lipase activity compared to the normotriglyceridemic patients (N = 8). All lipoprotein fractions collected by density gradient ultracentrifugation were triglyceride-enriched in the hypertriglyceridemic patients. Both groups of patients had elevated intermediate density lipoprotein levels, heterogeneity in the distribution of low density lipoproteins (LDL) and apoprotein-specific HDL subpopulations, and abnormalities in the size and composition of both LDL and HDL. The described alterations tended to be more marked in hypertriglyceridemic patients and are not detected by the usual laboratory evaluation of lipoproteins. These lipoprotein abnormalities have been shown to be atherogenic in patients without renal disease and are likely to contribute to the high prevalence of premature atherosclerosis in end-stage renal disease.