Issue: 2008 > February > review

Cholesterol in end-stage renal disease: the good, the bad or the ugly?



REVIEW
S.H.A. Diepeveen, J.F.M. Wetzels, H.J.G. Bilo, L.J.H. van Tits, A.F.H. Stalenhoef
AbstractPDF

Abstract

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.