RENALNA DISLIPIDEMIJA U BOLESNIKA NA KRONIČNOJ HEMODIJALIZI

Vedran Kovačić, Milenka Šain, Valentina Vukman

Sažetak. Važnu ulogu u razvoju ateroskleroze u bolesnika na kroničnoj hemodijalizi (BKHD) imaju lipidni poremećaji u krvi. Ti bolesnici imaju obrazac lipida u krvi čije su osobine povišenje triglicerida i sniženje HDL-kolesterola. Fenotip poremećaja lipida u uremičnih bolesnika uglavnom je tip IV po Fredricksonu (oko 30%), a manji dio otpada na IIA i na IIB. Oko 9% lipidnih poremećaja uremičara otpada na izolirano povišenje Lp(a). Glavni uzrok hipertrigliceridemije u BKHD je smanjen metabolizam VLDL-kolesterola zbog inhibicije lipoproteinske lipaze. Također postoje aterogene promjene u sastavu lipoproteina, osobito su aterogene promjene LDL-čestice. Liječenje renalne dislipidemije treba biti odlučno, i to na početku bubrežnog zatajenja.  Na raspolaganju nam stoje dijetalne mjere (osobito omega-3-masne kiseline), statini, gemfibrozil, intravenski L-karnitin i bikarbonati per os. U tom smislu važne su i modifikacije postupka hemodijalize kao što je visokoprotočna hemodijaliza, niskomolekularni heparin, dijalizatori obloženi vitaminom E, a za tvrdokorne slučajeve služi i LDL-afereza.

Summary. Disorder of blood lipids plays an important role in atherosclerosis progress in patients ongoing chronic haemodialysis (PCHD). These patients have specific features of blood lipids with increment of triglycerides and decrement of HDL-cholesterol. Phenotype of lipid disorder in PCHD is mostly type IV according to Fredrickson (30%), and IIA and IIB fenotypes are less frequent. About 9% of lipid disorders in PCHD are isolated increase of Lp(a). Main reason of hypertriglyceridemia in PCHD is attenuated metabolism of VLDL-cholesterol because of lipoprotein lipasis inhibition. There are changes in lipoproteins quality, specially changes in LDL particle have atherogenic potential. Renal dyslipidemia treatment must be vigorous in the early stages of renal insufficiency. Treatment can be dietary measures (specially omega-3-fatty acids), statins, gemfibrozil, intravenous L-carnitin and bicarbonate given per os. Haemodialysis modifications such as highflux haemodialysis, low molecular weight heparin, vitamin E coated dialyzers and LDL-apheresis in extreme cases have important role in renal dyslipidemia treatment.