Subspecialty Clinics: Nephrology Hyperlipoproteinemia in Adults With Renal Disease

Hyperlipoproteinemia is common in patients with renal disease, but increased lipids are only one of several risk factors frequently identified for coronary artery disease. Before treatment options are instituted, renal disease status, current medications, and possible interactions between drugs must be considered. Hypertriglyceridemia is common in patients with renal failure; therapeutic options are influenced by the levels of serum triglycerides and high-density lipoprotein cholesterol. Ifnonsteroidal drugs improve renal function and decrease proteinuria in patients with renal disease, hyperlipidemia frequently abates. Interactions between drugs are important considerations when lipid-lowering drug treatment is prescribed in recipients of renal transplants. Hyperlipoproteinemia is commonly found in three groups of patients with renal disease: those who have renal failure, nephrotic syndrome, or complications after receipt of a renal allograft. The importance of hyperlipoproteinemia primarily relates to its role in the development of atherosclerosis in these patients. Although hyperlipoproteinemia may contrib­ ute to loss of renal function in some animal models, I any role in the progression of renal disease in humans remains un­ clear. 2 Atherosclerosis, particularly coronary artery disease, is an important cause of increased morbidity and mortality in all three groups of patients. Hyperlipoproteinemia is only one of several risk factors for coronary artery disease; other factors include the male sex, a family history of premature coronary artery disease, cigarette smoking, hypertension, high-density lipoprotein (HDL) cholesterol of less than 35 mg/dl, diabetes mellitus, a history of cerebrovascular or occlusive peripheral vascular disease, and severe obesity.' No published information suggests that hyperlipoprotein­ emia is more or less important in the development of symp­ tomatic atherosclerosis in patients with renal disease. In the