Chronic renal failure and hyperlipidaemia

Hypertriglyceridaemia is the characteristic hyperlipidaemia associated with chronic renal failure (without proteinaemia):

• proportion of triglyceride in VLD and LDL is increased
• decreased rate of activity of lipoprotein lipase and hepatic lipase - remnant particles persist for long in the circulation
• haemodialysis leads to an exacerbation of hypertriglyceridaemia:
  • heparin leads to a depletion of lipoprotein lipase
  • apolipoprotein CII (co-factor for lipoprotein lipase) is removed from the circulation
• chronic ambulatory peritoneal dialysis results in absorption of large amounts of glucose which predisposes to obesity (thus exacerbating hypertriglyceridaemia)
• lipoprotein (a) (Lp(a)) levels are raised in renal disease
• HDL levels are low