Abstract:

Objective To compare the renal replacement modalities of high permeable hemodialysis (HPD), conventional hemodialysis (CHD) and continuous ambulatory peritoneal dialysis (CAPD) on lipid metabolism in patients with end stage renal disease of non-diabetic causes. Methods Ninety patients with end stage renal disease were treated with maintenance renal replacement therapy of HPD (n=30), CHD (n=30) or CAPD (n=30) for 3 years. Serum lipids were measured every 3 months. Of the 10 cases changed from hemodialysis to CAPD and the 10 cases changed from CAPD to hemodialysis, we observed their alterations in serum lipids before the change and after the new renal replacement therapy for 1 year. Results At the beginning of the treatment, no significant differences in serum lipids were found among the 3 groups. In patients treated with HPD, serum total cholesterol (TC), triglycerides (TG), low-density lipoprotein (LDL) and apolipoprotein B (Apo-B) decreased, and high-density lipoprotein (HDL) and apolipoprotein A (Apo-A) increased gradually after the treatment. However, in those treated with CHD and CAPD, TC, TG, LDL and Apo-B increased, HDL and Apo-A decreased gradually after the treatment, and the increase of TG was most remarkable (P<0.01). In the 10 patients first treated with CHD and then changed to CAPD for one year, TC and TG increased significantly (P<0.01). In contrast, in those first treated with CAPD and then changed to CHD for one year, no significant alterations in serum lipids were found, except the increase of Apo-B from 0.81±0.61 to 0.94.±0.35g/L (P<0.05). Conclusion The derangement of lipid metabolism in uremic patients was aggravated by CHD and especially by CAPD, but was improved by HPD. After renal replacement therapy for 3 years, the increase of TC and TG was higher in patients treated with CAPD than in those treated with CHD.

Key words: Conventional hemodialysis, Continuous ambulatory peritoneal dialysis, Lipid metabolism