Effects of conventional vs. low-molecular-weight heparin on lipid profile in hemodialysis patients.

Cardiovascular disease is one of the major causes of death in hemodialysis patients and seems to be related, at least in part, to lipid abnormalities. It has been suggested that in these patients low-molecular-weight heparin (LMWH) is superior to conventional heparin because it causes less side effects and has beneficial effects on lipid parameters. Our study was carried out to examine the long-term effects of the replacement of conventional heparin by LMWH on the lipoprotein profile in a large group of hemodialysis patients. A total of 76 patients aged 15-61 years receiving hemodialysis for 48 (range 10-169) months were studied. In all patients administration of LMWH was introduced in doses of 2,500-5,000 anti-factor Xa units for 12 months. Then, we randomly switched half of the patients back to conventional heparin for another 12 months, while the remaining patients continued to receive LMWH for 12 months. In the whole group of patients the use of LMWH instead of conventional heparin was followed by a significant decrease in serum total cholesterol, triglyceride and apoprotein B levels. The continued use of LMWH for another 12 months in half of the patients was followed by a further significant improvement in the lipid profile. In contrast, no significant changes in serum lipid parameters were observed in patients switched back to conventional heparin. In conclusion, the use of LMWH instead of conventional heparin for anticoagulation during hemodialysis is followed by an improvement in lipid profile, which is evident only after long-term treatment.

Lipid parameters including lipoprotein (a) in patients undergoing CAPD and hemodialysis.

OBJECTIVE: Dyslipidemia possibly contributes to the vascular complications commonly afflicting uremic patients. Lipoprotein (a) [Lp(a)] has been identified as an independent risk factor for atherosclerotic vascular disease. The aim of our study was to compare lipidparameters, including Lp(a), between hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD) patients. DESIGN: A cross-sectional study. SETTING: University Medical Center. PARTICIPANTS: Forty CAPD and 40 HD patients carefully matched for age, sex, body mass index (BMI), smoking habits, and duration of dialysis were studied. A group of 40 healthy individuals matched for age, sex, BMI, and smoking habits was used as control. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Serum lipid parameters and atherogenic risk ratios were the main outcome measures. RESULTS: Both groups of dialysis patients had increased serum triglycerides and decreased levels of ApoA1 and HDL cholesterol compared to controls. Moreover, the risk ratios total cholesterol/HDL cholesterol and LDL cholesterol/HDL cholesterol were significantly higher, and the ratio ApoA1/ApoB was significantly lower in both groups of patients in comparison to the normal subjects. Both groups of dialysis patients exhibited decreased ratios of LDL cholesterol/ApoB and HDL cholesterol/ApoA1, suggesting the presence of compositional lipoprotein changes. CAPD patients had a more atherogenic lipid profile compared to HD patients, since they exhibited higher levels of total and LDL cholesterol, of ApoB as well as of the ratios total cholesterol/HDL cholesterol and LDL cholesterol/HDL cholesterol, and lower levels of the ratio ApoA1/ApoB compared to HD patients. Both groups of dialysis patients had increased serum Lp(a) levels. Even though CAPD patients had higher serum Lp(a) levels than HD patients, the differences between these two groups were only marginally statistically significant (p = 0.056 by Mann-Whitney U-test). Uremic dyslipidemia was positively correlated with serum albumin levels in both groups of patients. CONCLUSION: CAPD patients exhibit a more atherogenic lipid profile than that of HD patients. The marked disturbances in Lp(a) levels may further increase the vascular risk in both groups of patients.