Typical lipid profile in CKD

Typical lipid profile in CKD

What is the typical lipid profile in patients with chronic kidney disease (CKD)?

Dyslipidemias are common in patients with CKD, those on dialysis (both hemodialysis and peritoneal dialysis), and those who have undergone kidney transplantation.

Dyslipidemia is also prevalent in over 60% of people who have received cardiac or liver transplantation, and this may be partially due to the long-term use of calcineurin inhibitors and/or steroids as immunosuppressants.

Proteinuria, and particularly nephrotic syndrome, is associated with a greater elevation in total cholesterol, low-density lipoprotein (LDL) cholesterol, triglycerides, and lipoprotein(a) (Lp-a) than in persons with CKD without proteinuria.

The concentration of high-density lipoprotein (HDL) cholesterol is also often reduced in nephrotic syndrome.

Hemodialysis and peritoneal dialysis patients have increased levels of triglycerides and Lp-a compared to patients with milder degrees of CKD, with peritoneal dialysis patients having particularly atherogenic lipid profiles, perhaps due to constant dextrose absorption.

LDL cholesterol is often normal or low in hemodialysis patients, perhaps due to poor nutrition and chronic inflammation. 

The below table depicts the most common lipid abnormalities seen across the spectrum of kidney disease.

Lipid Profiles Across the Spectrum of Kidney Disease as Compared to the General Population

CKD NOT ON DIALYSIS	NEPHROTIC SYNDROME	HEMODIALYSIS	PERITONEAL DIALYSIS	POST-TRANSPLANT
Total cholesterol	↑ or ↔	↑ ↑	↓ or ↔	↑ or ↔	↑ or ↔
HDL cholesterol	↓ or ↔	↓	↓	↓	↓ or ↔
LDL cholesterol	↑	↑ ↑	↓	↑	↑
Triglycerides	↑	↑ ↑	↑	↑ ↑	↑ or ↔
Lp(a)		↑	↑ ↑	↑ ↑	↑ or ↔

CKD, Chronic kidney disease; HDL, high-density lipoprotein; LDL, low-density lipoprotein; Lp(a ), lipoprotein(a).

Modified from Kwan, B.C., Kronenberg, F., Beddhu, S., et al. (2007). Lipoprotein metabolism and lipid management in chronic kidney disease. J Am Soc Nephrol . 18(4):1246–1261.