Journal Mobile Options
Table of Contents
Vol. 27, No. 1, 2009
Issue release date: January 2009
Section title: Paper
Blood Purif 2009;27:86–91
(DOI:10.1159/000167015)

New Insights into Lipid Metabolism in Chronic Kidney Disease: What Are the Practical Implications?

Kaysen G.A.
Division of Nephrology, Departments of Medicine and of Biochemistry and Molecular Medicine, UC Davis, Davis, Calif., and Department of Veterans Affairs, Northern California Health Care System, Mather, Calif., USA
email Corresponding Author

Abstract

The risk of cardiovascular disease increases with declining glomerular filtration rate. Hyperlipidemia and dyslipidemia, characterized by increased triglycerides and low levels of high-density lipoprotein, are both associated with cardiovascular outcome as well as the risk of progression of loss of renal function. Both hyperlipidemia and dyslipidemia respond to pharmacologic therapy, including hydroxymethylglutaryl-CoA reductase inhibitors and fibric acid derivatives, to alteration in diet as well as to extreme measures such as bariatric surgery. However, the effects of these modalities on cardiovascular or renal outcomes are dependent upon the level of renal function. There is strong evidence that patients with stages 1–3 chronic kidney disease attain benefit from lipid-lowering therapy both with reduction in cardiovascular risk and possibly reduction in the rate of decline in renal function. Among dialysis patients little risk reduction appears to be achieved by treatment of low-density lipoprotein cholesterol level. Bariatric surgery reduces hyperlipidemia in patients with chronic kidney disease, but has also been associated with subsequent rapid decline in renal function secondary to oxalate deposition.

© 2009 S. Karger AG, Basel


  

Key Words

  • Low-density lipoprotein
  • High-density lipoprotein
  • Very-low-density lipoprotein
  • Remnant particles
  • Inflammation
  • Fibric acid
  • Statins

References

  1. Go AS, Chertow GM, Fan D, McCulloch CE, Hsu CY: Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med 2004;351:1296–1305.
  2. Yeun JY, Levine RA, Mantadilok V, Kaysen GA: C-reactive protein predicts all-cause and cardiovascular mortality in hemodialysis patients. Am J Kidney Dis 2000;35:469–476.
  3. Kaysen GA, Eiserich JP: The role of oxidative stress-altered lipoprotein structure and function and microinflammation on cardiovascular risk in patients with minor renal dysfunction. J Am Soc Nephrol 2004;15:538–548.
  4. Lowrie EG, Lew NL: Death risk in hemodialysis patients: the predictive value of commonly measured variables and an evaluation of death rate differences between facilities. Am J Kidney Dis 1990;15:458–482.
  5. Chertow GM, Goldstein-Fuchs DJ, Lazarus JM, Kaysen GA: Prealbumin, mortality, and cause-specific hospitalization in hemodialysis patients. Kidney Int 2005;68:2794–2800.
  6. Muntner P, Coresh J, Smith JC, Eckfeldt J, Klag MJ: Plasma lipids and risk of developing renal dysfunction: the atherosclerosis risk in communities study. Kidney Int 2000;58:293–301.
  7. Kurella M, Lo JC, Chertow GM: Metabolic syndrome and the risk for chronic kidney disease among nondiabetic adults. J Am Soc Nephrol 2005;16:2134–2140.
  8. Grundy SM, Brewer HB Jr, Cleeman JI, Smith SC Jr, Lenfant C; American Heart Association, National Heart, Lung, and Blood Institute: Definition of metabolic syndrome: report of the National Heart, Lung, and Blood Institute/American Heart Association conference on scientific issues related to definition. Circulation 2004;109:433–438.
  9. Gelber RP, Kurth T, Kausz AT, Manson JE, Buring JE, Levey AS, Gaziano JM: Association between body mass index and CKD in apparently healthy men. Am J Kidney Dis 2005;46:871–880.
  10. Fox CS, Larson MG, Leip EP, Culleton B, Wilson PW, Levy D: Predictors of new-onset kidney disease in a community-based population. JAMA 2004;291:844–850.
  11. Hocher B, Ziebig R, Altermann C, et al: Different impact of biomarkers as mortality predictors among diabetic and nondiabetic patients undergoing hemodialysis. J Am Soc Nephrol 2003;14:2329–2337.
  12. Stompor T, Pasowicz M, Sullowicz W, Dembinska-Kiec A, Janda K, Wojcik K, Tracz W, Zdzienicka A, Klimeczek P, Janusz-Grzybowska E: An association between coronary artery calcification score, lipid profile, and selected markers of chronic inflammation in ESRD patients treated with peritoneal dialysis. Am J Kidney Dis 2003;41:203–211.
  13. Welty FK, Lichtenstein AH, Barrett PH, Dolnikowski GG, Schaefer EJ: Interrelationships between human apolipoprotein A-I and apolipoproteins B-48 and B-100 kinetics using stable isotopes. Arterioscler Thromb Vasc Biol 2004;24:1703–1707.
  14. Quintao EC, Medina WL, Passarelli M: Related reverse cholesterol transport in diabetes mellitus. Diabetes Metab Res Rev 2000;16:237–250.
  15. Mekki K, Bouchenak M, Lamri M, Remaoun M, Belleville J: Changes in plasma lecithin: cholesterol acyltransferase activity, HDL(2), HDL(3) amounts and compositions in patients with chronic renal failure after different times of hemodialysis. Atherosclerosis 2002;162:409–417.
  16. Boaz M, Matas Z, Biro A, Katzir Z, Green M, Fainaru M, Smetana S: Comparison of hemostatic factors and serum malondialdehyde as predictive factors for cardiovascular disease in hemodialysis patients. Am J Kidney Dis 1999;34:438–444.
  17. Sakata K, Kashiwagi K, Sharmin S, Ueda S, Irie Y, Murotani N, Igarashi K: Increase in putrescine, amine oxidase, and acrolein in plasma of renal failure patients. Biochem Biophys Res Commun 2003;305:143–149.
  18. Vaziri ND, Liang K, Parks JS: Down-regulation of hepatic lecithin: cholesterol acyltransferase gene expression in chronic renal failure. Kidney Int 2001;59:2192–2196.
  19. Odamaki M, Furuya R, Ohkawa S, Yoneyama T, Nishikino M, Hishida A, Kumagai H: Altered abdominal fat distribution and its association with the serum lipid profile in non-diabetic haemodialysis patients. Nephrol Dial Transplant 1999;14:2427–2432.
  20. Schupf N, Costa R, Luchsinger J, Tang MX, Lee JH, Mayeux R: Relationship between plasma lipids and all-cause mortality in nondemented elderly. J Am Geriatr Soc 2005;53:219–226.
  21. Seliger SL, Weiss NS, Gillen DL, Kestenbaum B, Ball A, Sherrard DJ, Stehman-Breen CO: HMG-CoA reductase inhibitors are associated with reduced mortality in ESRD patients. Kidney Int 2002;61:297–304.
  22. Wanner C, Krane V, März W, Olschewski M, Mann JF, Ruf G, Ritz E; German Diabetes and Dialysis Study Investigators: Atorvastatin in patients with type 2 diabetes mellitus undergoing hemodialysis. N Engl J Med 2005;353:238–248.
  23. Shepherd J, Kastelein JJ, Bittner V, Deedwania P, Breazna A, Dobson S, Wilson DJ, Zuckerman A, Wenger NK; TNT (Treating to New Targets) Investigators: Intensive lipid lowering with atorvastatin in patients with coronary heart disease and chronic kidney disease: the TNT (Treating to New Targets) study. J Am Coll Cardiol 2008;51:1448–1454.
  24. Shepherd J, Kastelein JJ, Bittner V, Deedwania P, Breazna A, Dobson S, Wilson DJ, Zuckerman A, Wenger NK; Treating to New Targets Investigators: Effect of intensive lipid lowering with atorvastatin on renal function in patients with coronary heart disease: the Treating to New Targets (TNT) study. Clin J Am Soc Nephrol 2007;2:1131–1139.
  25. Akçiçek F, Ok E, Duman S, Kürsad S, Unsal A, Alev M, Atabay G, Basçi A: Lipid-lowering effects of simvastatin and gemfibrozil in CAPD patients: a prospective cross-over study. Adv Perit Dial 1996;12:261–265.

    External Resources

  26. Massy ZA, Ma JZ, Louis TA, Kasiske BL: Lipid-lowering therapy in patients with renal disease. Kidney Int 1995;48:188–198.
  27. Dogra G, Irish A, Chan D, Watts G: A randomized trial of the effect of statin and fibrate therapy on arterial function in CKD. Am J Kidney Dis 2007;49:776–785.
  28. Nagai T, Tomizawa T, Nakajima K, Mori M: Effect of bezafibrate or pravastatin on serum lipid levels and albuminuria in NIDDM patients. J Atheroscler Thromb 2000;7:91–96.
  29. Tonelli M, Collins D, Robins S, Bloomfield H, Curhan GC: Effect of gemfibrozil on change in renal function in men with moderate chronic renal insufficiency and coronary disease. Am J Kidney Dis 2004;44:832–839.
  30. Tonelli M, Collins D, Robins S, Bloomfield H, Curhan GC; Veterans’ Affairs High-Density Lipoprotein Intervention Trial (VA-HIT) Investigators: Gemfibrozil for secondary prevention of cardiovascular events in mild to moderate chronic renal insufficiency. Kidney Int 2004;66:1123–1130.
  31. Alabakovska SB, Todorova BB, Labudovic DD, Tosheska KN: Related LDL and HDL subclass distribution in patients with end-stage renal diseases. Clin Biochem 2002;35:211–216.
  32. Garvey WT, Kwon S, Zheng D, Shaughnessy S, Wallace P, Hutto A, Pugh K, Jenkins AJ, Klein RL, Liao Y: Effects of insulin resistance and type 2 diabetes on lipoprotein subclass particle size and concentration determined by nuclear magnetic resonance. Diabetes 2003;52:453–462.
  33. Morena M, Cristol JP, Dantoine T, Carbonneau MA, Descomps B, Canaud B: Protective effects of high-density lipoprotein against oxidative stress are impaired in haemodialysis patients. Nephrol Dial Transplant 2000;15:389–395.
  34. Himmelfarb J, Phinney S, Ikizler TA, Kane J, McMonagle E, Miller G: Gamma-tocopherol and docosahexaenoic acid decrease inflammation in dialysis patients. J Ren Nutr 2007;17:296–304.
  35. Islam KN, O’Byrne D, Devaraj S, Palmer B, Grundy SM, Jialal I: Alpha-tocopherol supplementation decreases the oxidative susceptibility of LDL in renal failure patients on dialysis therapy. Atherosclerosis 2000;150:217–224.
  36. Yusuf S, Dagenais G, Pogue J, Bosch J, Sleight P: Vitamin E supplementation and cardiovascular events in high-risk patients. The Heart Outcomes Prevention Evaluation Study Investigators. N Engl J Med 2000;342:154–160.
  37. Gelber RP, Kurth T, Kausz AT, Manson JE, Buring JE, Levey AS, Gaziano JM: Association between body mass index and CKD in apparently healthy men. Am J Kidney Dis 2005;46:871–880.
  38. Kramer HJ, Saranathan A, Luke A, Durazo-Arvizu RA, Guichan C, Hou S, Cooper R: Increasing body mass index and obesity in the incident ESRD population. J Am Soc Nephrol 2006;17:1453–1459.
  39. Packard DP, Milton JE, Shuler LA, Short RA, Tuttle KR: Implications of chronic kidney disease for dietary treatment in cardiovascular disease. J Ren Nutr 2006;16:259–268.
  40. Appel LJ, Brands MW, Daniels SR, Karanja N, Elmer PJ, Sacks FM; American Heart Association: Dietary approaches to prevent and treat hypertension: a scientific statement from the American Heart Association. Hypertension 2006;47:296–308.
  41. Reddy ST, Wang CY, Sakhaee K, Brinkley L, Pak CY: Effect of low-carbohydrate high-protein diets on acid-base balance, stone-forming propensity, and calcium metabolism. Am J Kidney Dis 2002;40:265–274.
  42. Batsis JA, Romero-Corral A, Collazo-Clavell ML, Sarr MG, Somers VK, Lopez-Jimenez F: Effect of bariatric surgery on the metabolic syndrome: a population-based, long-term controlled study. Mayo Clin Proc 2008;83:897–907.
  43. Frige’ F, Laneri M, Veronelli A, Folli F, Paganelli M, Vedani P, Marchi M, Noe’ D, Ventura P, Opocher E, Pontiroli AE: Bariatric surgery in obesity: changes of glucose and lipid metabolism correlate with changes of fat mass. Nutr Metab Cardiovasc Dis 2008, E-pub ahead of print.
  44. Kligman MD, Dexter DJ, Omer S, Park AE: Shrinking cardiovascular risk through bariatric surgery: application of Framingham risk score in gastric bypass. Surgery 2008;143:533–538.
  45. Alexander JW, Goodman H: Gastric bypass in chronic renal failure and renal transplant. Nutr Clin Pract 2007;22:16–22.
  46. Nasr SH, D’Agati VD, Said SM, Stokes MB, Largoza MV, Radhakrishnan J, Markowitz GS: Oxalate nephropathy complicating Roux-en-Y gastric bypass: an underrecognized cause of irreversible renal failure. Clin J Am Soc Nephrol 2008, E-pub ahead of print.
  47. Hassan I, Juncos LA, Milliner DS, Sarmiento JM, Sarr MG: Chronic renal failure secondary to oxalate nephropathy: a preventable complication after jejunoileal bypass. Mayo Clin Proc 2001;76:758–760.
  48. Sharma SK, McCauley J, Cottam D, Mattar SG, Holover S, Dallal R, Lord J, Danner O, Ramanathan R, Eid G, Schauer P: Acute changes in renal function after laparoscopic gastric surgery for morbid obesity. Surg Obes Relat Dis 2006;2:389–392.

  

Author Contacts

George A. Kaysen, MD, PhD
Division of Nephrology, University of California Davis
One Shields Ave., GMSF Room 6311
Davis, CA 95616 (USA)
Tel. +1 530 752 4010, Fax +1 530 752 3791, E-Mail gakaysen@ucdavis.edu

  

Article Information

Published online: January 23, 2009
Number of Print Pages : 6
Number of Figures : 1, Number of Tables : 0, Number of References : 48

  

Publication Details

Blood Purification

Vol. 27, No. 1, Year 2009 (Cover Date: January 2009)

Journal Editor: Ronco C. (Vicenza)
ISSN: 0253-5068 (Print), eISSN: 1421-9735 (Online)

For additional information: http://www.karger.com/BPU


Copyright / Drug Dosage / Disclaimer

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

Abstract

The risk of cardiovascular disease increases with declining glomerular filtration rate. Hyperlipidemia and dyslipidemia, characterized by increased triglycerides and low levels of high-density lipoprotein, are both associated with cardiovascular outcome as well as the risk of progression of loss of renal function. Both hyperlipidemia and dyslipidemia respond to pharmacologic therapy, including hydroxymethylglutaryl-CoA reductase inhibitors and fibric acid derivatives, to alteration in diet as well as to extreme measures such as bariatric surgery. However, the effects of these modalities on cardiovascular or renal outcomes are dependent upon the level of renal function. There is strong evidence that patients with stages 1–3 chronic kidney disease attain benefit from lipid-lowering therapy both with reduction in cardiovascular risk and possibly reduction in the rate of decline in renal function. Among dialysis patients little risk reduction appears to be achieved by treatment of low-density lipoprotein cholesterol level. Bariatric surgery reduces hyperlipidemia in patients with chronic kidney disease, but has also been associated with subsequent rapid decline in renal function secondary to oxalate deposition.

© 2009 S. Karger AG, Basel


  

Author Contacts

George A. Kaysen, MD, PhD
Division of Nephrology, University of California Davis
One Shields Ave., GMSF Room 6311
Davis, CA 95616 (USA)
Tel. +1 530 752 4010, Fax +1 530 752 3791, E-Mail gakaysen@ucdavis.edu

  

Article Information

Published online: January 23, 2009
Number of Print Pages : 6
Number of Figures : 1, Number of Tables : 0, Number of References : 48

  

Publication Details

Blood Purification

Vol. 27, No. 1, Year 2009 (Cover Date: January 2009)

Journal Editor: Ronco C. (Vicenza)
ISSN: 0253-5068 (Print), eISSN: 1421-9735 (Online)

For additional information: http://www.karger.com/BPU


Article / Publication Details

First-Page Preview
Abstract of Paper

Published online: 1/23/2009
Issue release date: January 2009

Number of Print Pages: 6
Number of Figures: 1
Number of Tables: 0

ISSN: 0253-5068 (Print)
eISSN: 1421-9735 (Online)

For additional information: http://www.karger.com/BPU


Copyright / Drug Dosage

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

References

  1. Go AS, Chertow GM, Fan D, McCulloch CE, Hsu CY: Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med 2004;351:1296–1305.
  2. Yeun JY, Levine RA, Mantadilok V, Kaysen GA: C-reactive protein predicts all-cause and cardiovascular mortality in hemodialysis patients. Am J Kidney Dis 2000;35:469–476.
  3. Kaysen GA, Eiserich JP: The role of oxidative stress-altered lipoprotein structure and function and microinflammation on cardiovascular risk in patients with minor renal dysfunction. J Am Soc Nephrol 2004;15:538–548.
  4. Lowrie EG, Lew NL: Death risk in hemodialysis patients: the predictive value of commonly measured variables and an evaluation of death rate differences between facilities. Am J Kidney Dis 1990;15:458–482.
  5. Chertow GM, Goldstein-Fuchs DJ, Lazarus JM, Kaysen GA: Prealbumin, mortality, and cause-specific hospitalization in hemodialysis patients. Kidney Int 2005;68:2794–2800.
  6. Muntner P, Coresh J, Smith JC, Eckfeldt J, Klag MJ: Plasma lipids and risk of developing renal dysfunction: the atherosclerosis risk in communities study. Kidney Int 2000;58:293–301.
  7. Kurella M, Lo JC, Chertow GM: Metabolic syndrome and the risk for chronic kidney disease among nondiabetic adults. J Am Soc Nephrol 2005;16:2134–2140.
  8. Grundy SM, Brewer HB Jr, Cleeman JI, Smith SC Jr, Lenfant C; American Heart Association, National Heart, Lung, and Blood Institute: Definition of metabolic syndrome: report of the National Heart, Lung, and Blood Institute/American Heart Association conference on scientific issues related to definition. Circulation 2004;109:433–438.
  9. Gelber RP, Kurth T, Kausz AT, Manson JE, Buring JE, Levey AS, Gaziano JM: Association between body mass index and CKD in apparently healthy men. Am J Kidney Dis 2005;46:871–880.
  10. Fox CS, Larson MG, Leip EP, Culleton B, Wilson PW, Levy D: Predictors of new-onset kidney disease in a community-based population. JAMA 2004;291:844–850.
  11. Hocher B, Ziebig R, Altermann C, et al: Different impact of biomarkers as mortality predictors among diabetic and nondiabetic patients undergoing hemodialysis. J Am Soc Nephrol 2003;14:2329–2337.
  12. Stompor T, Pasowicz M, Sullowicz W, Dembinska-Kiec A, Janda K, Wojcik K, Tracz W, Zdzienicka A, Klimeczek P, Janusz-Grzybowska E: An association between coronary artery calcification score, lipid profile, and selected markers of chronic inflammation in ESRD patients treated with peritoneal dialysis. Am J Kidney Dis 2003;41:203–211.
  13. Welty FK, Lichtenstein AH, Barrett PH, Dolnikowski GG, Schaefer EJ: Interrelationships between human apolipoprotein A-I and apolipoproteins B-48 and B-100 kinetics using stable isotopes. Arterioscler Thromb Vasc Biol 2004;24:1703–1707.
  14. Quintao EC, Medina WL, Passarelli M: Related reverse cholesterol transport in diabetes mellitus. Diabetes Metab Res Rev 2000;16:237–250.
  15. Mekki K, Bouchenak M, Lamri M, Remaoun M, Belleville J: Changes in plasma lecithin: cholesterol acyltransferase activity, HDL(2), HDL(3) amounts and compositions in patients with chronic renal failure after different times of hemodialysis. Atherosclerosis 2002;162:409–417.
  16. Boaz M, Matas Z, Biro A, Katzir Z, Green M, Fainaru M, Smetana S: Comparison of hemostatic factors and serum malondialdehyde as predictive factors for cardiovascular disease in hemodialysis patients. Am J Kidney Dis 1999;34:438–444.
  17. Sakata K, Kashiwagi K, Sharmin S, Ueda S, Irie Y, Murotani N, Igarashi K: Increase in putrescine, amine oxidase, and acrolein in plasma of renal failure patients. Biochem Biophys Res Commun 2003;305:143–149.
  18. Vaziri ND, Liang K, Parks JS: Down-regulation of hepatic lecithin: cholesterol acyltransferase gene expression in chronic renal failure. Kidney Int 2001;59:2192–2196.
  19. Odamaki M, Furuya R, Ohkawa S, Yoneyama T, Nishikino M, Hishida A, Kumagai H: Altered abdominal fat distribution and its association with the serum lipid profile in non-diabetic haemodialysis patients. Nephrol Dial Transplant 1999;14:2427–2432.
  20. Schupf N, Costa R, Luchsinger J, Tang MX, Lee JH, Mayeux R: Relationship between plasma lipids and all-cause mortality in nondemented elderly. J Am Geriatr Soc 2005;53:219–226.
  21. Seliger SL, Weiss NS, Gillen DL, Kestenbaum B, Ball A, Sherrard DJ, Stehman-Breen CO: HMG-CoA reductase inhibitors are associated with reduced mortality in ESRD patients. Kidney Int 2002;61:297–304.
  22. Wanner C, Krane V, März W, Olschewski M, Mann JF, Ruf G, Ritz E; German Diabetes and Dialysis Study Investigators: Atorvastatin in patients with type 2 diabetes mellitus undergoing hemodialysis. N Engl J Med 2005;353:238–248.
  23. Shepherd J, Kastelein JJ, Bittner V, Deedwania P, Breazna A, Dobson S, Wilson DJ, Zuckerman A, Wenger NK; TNT (Treating to New Targets) Investigators: Intensive lipid lowering with atorvastatin in patients with coronary heart disease and chronic kidney disease: the TNT (Treating to New Targets) study. J Am Coll Cardiol 2008;51:1448–1454.
  24. Shepherd J, Kastelein JJ, Bittner V, Deedwania P, Breazna A, Dobson S, Wilson DJ, Zuckerman A, Wenger NK; Treating to New Targets Investigators: Effect of intensive lipid lowering with atorvastatin on renal function in patients with coronary heart disease: the Treating to New Targets (TNT) study. Clin J Am Soc Nephrol 2007;2:1131–1139.
  25. Akçiçek F, Ok E, Duman S, Kürsad S, Unsal A, Alev M, Atabay G, Basçi A: Lipid-lowering effects of simvastatin and gemfibrozil in CAPD patients: a prospective cross-over study. Adv Perit Dial 1996;12:261–265.

    External Resources

  26. Massy ZA, Ma JZ, Louis TA, Kasiske BL: Lipid-lowering therapy in patients with renal disease. Kidney Int 1995;48:188–198.
  27. Dogra G, Irish A, Chan D, Watts G: A randomized trial of the effect of statin and fibrate therapy on arterial function in CKD. Am J Kidney Dis 2007;49:776–785.
  28. Nagai T, Tomizawa T, Nakajima K, Mori M: Effect of bezafibrate or pravastatin on serum lipid levels and albuminuria in NIDDM patients. J Atheroscler Thromb 2000;7:91–96.
  29. Tonelli M, Collins D, Robins S, Bloomfield H, Curhan GC: Effect of gemfibrozil on change in renal function in men with moderate chronic renal insufficiency and coronary disease. Am J Kidney Dis 2004;44:832–839.
  30. Tonelli M, Collins D, Robins S, Bloomfield H, Curhan GC; Veterans’ Affairs High-Density Lipoprotein Intervention Trial (VA-HIT) Investigators: Gemfibrozil for secondary prevention of cardiovascular events in mild to moderate chronic renal insufficiency. Kidney Int 2004;66:1123–1130.
  31. Alabakovska SB, Todorova BB, Labudovic DD, Tosheska KN: Related LDL and HDL subclass distribution in patients with end-stage renal diseases. Clin Biochem 2002;35:211–216.
  32. Garvey WT, Kwon S, Zheng D, Shaughnessy S, Wallace P, Hutto A, Pugh K, Jenkins AJ, Klein RL, Liao Y: Effects of insulin resistance and type 2 diabetes on lipoprotein subclass particle size and concentration determined by nuclear magnetic resonance. Diabetes 2003;52:453–462.
  33. Morena M, Cristol JP, Dantoine T, Carbonneau MA, Descomps B, Canaud B: Protective effects of high-density lipoprotein against oxidative stress are impaired in haemodialysis patients. Nephrol Dial Transplant 2000;15:389–395.
  34. Himmelfarb J, Phinney S, Ikizler TA, Kane J, McMonagle E, Miller G: Gamma-tocopherol and docosahexaenoic acid decrease inflammation in dialysis patients. J Ren Nutr 2007;17:296–304.
  35. Islam KN, O’Byrne D, Devaraj S, Palmer B, Grundy SM, Jialal I: Alpha-tocopherol supplementation decreases the oxidative susceptibility of LDL in renal failure patients on dialysis therapy. Atherosclerosis 2000;150:217–224.
  36. Yusuf S, Dagenais G, Pogue J, Bosch J, Sleight P: Vitamin E supplementation and cardiovascular events in high-risk patients. The Heart Outcomes Prevention Evaluation Study Investigators. N Engl J Med 2000;342:154–160.
  37. Gelber RP, Kurth T, Kausz AT, Manson JE, Buring JE, Levey AS, Gaziano JM: Association between body mass index and CKD in apparently healthy men. Am J Kidney Dis 2005;46:871–880.
  38. Kramer HJ, Saranathan A, Luke A, Durazo-Arvizu RA, Guichan C, Hou S, Cooper R: Increasing body mass index and obesity in the incident ESRD population. J Am Soc Nephrol 2006;17:1453–1459.
  39. Packard DP, Milton JE, Shuler LA, Short RA, Tuttle KR: Implications of chronic kidney disease for dietary treatment in cardiovascular disease. J Ren Nutr 2006;16:259–268.
  40. Appel LJ, Brands MW, Daniels SR, Karanja N, Elmer PJ, Sacks FM; American Heart Association: Dietary approaches to prevent and treat hypertension: a scientific statement from the American Heart Association. Hypertension 2006;47:296–308.
  41. Reddy ST, Wang CY, Sakhaee K, Brinkley L, Pak CY: Effect of low-carbohydrate high-protein diets on acid-base balance, stone-forming propensity, and calcium metabolism. Am J Kidney Dis 2002;40:265–274.
  42. Batsis JA, Romero-Corral A, Collazo-Clavell ML, Sarr MG, Somers VK, Lopez-Jimenez F: Effect of bariatric surgery on the metabolic syndrome: a population-based, long-term controlled study. Mayo Clin Proc 2008;83:897–907.
  43. Frige’ F, Laneri M, Veronelli A, Folli F, Paganelli M, Vedani P, Marchi M, Noe’ D, Ventura P, Opocher E, Pontiroli AE: Bariatric surgery in obesity: changes of glucose and lipid metabolism correlate with changes of fat mass. Nutr Metab Cardiovasc Dis 2008, E-pub ahead of print.
  44. Kligman MD, Dexter DJ, Omer S, Park AE: Shrinking cardiovascular risk through bariatric surgery: application of Framingham risk score in gastric bypass. Surgery 2008;143:533–538.
  45. Alexander JW, Goodman H: Gastric bypass in chronic renal failure and renal transplant. Nutr Clin Pract 2007;22:16–22.
  46. Nasr SH, D’Agati VD, Said SM, Stokes MB, Largoza MV, Radhakrishnan J, Markowitz GS: Oxalate nephropathy complicating Roux-en-Y gastric bypass: an underrecognized cause of irreversible renal failure. Clin J Am Soc Nephrol 2008, E-pub ahead of print.
  47. Hassan I, Juncos LA, Milliner DS, Sarmiento JM, Sarr MG: Chronic renal failure secondary to oxalate nephropathy: a preventable complication after jejunoileal bypass. Mayo Clin Proc 2001;76:758–760.
  48. Sharma SK, McCauley J, Cottam D, Mattar SG, Holover S, Dallal R, Lord J, Danner O, Ramanathan R, Eid G, Schauer P: Acute changes in renal function after laparoscopic gastric surgery for morbid obesity. Surg Obes Relat Dis 2006;2:389–392.