Lipid and lipoprotein levels were measured in undialyzed uremic men and compared with levels of healthy control subjects. The patients had lower high-density lipoprotein (HDL) cholesterol (mean ± SD, 46.3 ± 14.8 vs 54.1 ± 18.2 mg/dl) and increased serum triglycerides (197 ± 151 vs 142 ± 87.7 mg/dl). When compared with patients maintained on dialysis, the undialyzed patients had higher HDL cholesterol (46.3 ± 14.8 vs 30.3 ± 13.3 mg/dl), serum cholesterol (226 ± 81 vs 151 ± 42 mg/dl), and triglycerides (197 ± 151 vs 146 ± 105 mg/dl). The low-density lipoprotein (LDL):high-density lipoprotein cholesterol ratios were 3.78, 3.24, and 2.84 in the dialyzed, undialyzed, and control groups, respectively. Lecithin:cholesterol acyl transferase activity of undialyzed patients was similar to controls when measured by an endogenous substrate assay (148 ± 112 vs 112 ± 28 nmol/ml/hr), but were significantly lower when assayed using exogenous substrate (73.3 ± 25.6 vs 112.8 ± 7 nmol/ml/hr). The rate of cholesterol transfer (RCT) from HDL to very low density lipoprotein and LDL was in the following order: dialyzed patients (1.85 ± 1.29 mg/dl/hr) < undialyzed patients (2.41 ± 1.57 mg/dl/hr) < control subjects (4.83 ± 3.13 mg/dl/hr). Within the undialyzed patient group, black patients had lower serum cholesterol and triglycerides and higher HDL and HDL3 cholesterol than white patients. Apoprotein A-I levels were higher and apoprotein B levels were lower in the black patients. There was a strong correlation (r = 0.9501) between apoprotein A-I and HDL levels in the black patients, but not in the white patients (r = -0.148). These data indicate the presence of lipid and lipoprotein abnormalities in early stages of renal failure, and that the risk of developing atherosclerosis may be higher in white than in black patients.
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