Cholesterol in end-stage renal disease: the good, the bad or the ugly?
The incidence of cardiovascular disease is markedly increased in patients with end-stage renal disease (ESRD). High serum cholesterol is widely recognised as a cardiovascular risk factor in the general population. However, in patients with ESRD high concentrations of cholesterol are associated with a better survival. This reverse epidemiology is, amongst others, caused by confounding due to malnutrition and chronic inflammation. In this population, treatment with statins to lower the serum cholesterol remains a matter of debate. In ESRD, LDL cholesterol is modified by increased oxidative stress. These altered LDL particles play a pivotal role in the development of atherosclerosis. Treatment with the antioxidant vitamin E has not equivocally been shown to be beneficial in this population. This review tries to put data from literature on dyslipidaemia and oxidative stress in ESRD in perspective.
Diepeveen
S H A
SH
Department of Internal Medicine, Isala Clinics, Zwolle, the Netherlands.
Wetzels
J F M
JF
Bilo
H J G
HJ
van Tits
L J H
LJ
Stalenhoef
A F H
AF
D002318:Cardiovascular Diseases / Q000209:etiology; D002784:Cholesterol / Q000097:blood*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D007676:Kidney Failure, Chronic / Q000097:blood / Q000188:drug therapy; D018384:Oxidative Stress; D012307:Risk Factors
D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D002784:Cholesterol