FACTORS AFFECTING SERUM LIPID LEVELS IN RENAL PATIENTS UNDERGOING MAINTENANCE HEMODIALYSIS OR CONTINUOUS AMBULATORY PERITONEAL DIALYSIS TREATMENTS (DISEASE, DIET THERAPY).

摘要

Two studies were conducted in order to determine whether dietary factors, anthropometric measurements, activity levels, and blood glucose (BG), urea nitrogen (BUN), and creatinine levels influence serum levels of total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), and triglycerides (TG) in persons undergoing hemodialysis (HD) or continuous ambulatory peritoneal dialysis (CAPD) therapy for chronic renal failure. In the first study, data were obtained from medical records. In the second study, multiple 24-hour recalls, activity recalls, body skinfold measurements, and blood samples for determination of lipid levels were collected directly from subjects. Multiple regression analysis was used to develop models to predict lipid levels on the basis of the variables measured. Student's t-test (in the first study) and analysis of covariance, adjusting for age (in the second study) were used to test for differences between HD and CAPD subjects with respect to the variables measured.;CAPD subjects were found to have higher TC, TG, and BG levels than HD subjects in the first study; in the second study, no such differences were found. HDL-C levels were below standard levels in both groups of subjects in both studies. In the first study, HDL-C was found to be negatively associated with percent ideal body weight (PIBW), Quetelet Index (QI), dietary intakes of energy, fat, and carbohydrate, and serum creatinine levels. TC was positively associated with serum creatinine levels in all subjects, and with intake of energy and carbohydrate from dialysate in CAPD subjects. TG was positively associated with QI and PIBW. In the second study, TC was negatively associated with dietary intake of energy and carbohydrate. Because small sample sizes limited the number of variables that could be included in regression models, the models developed in both studies were able to explain less than half of the variability in serum lipid levels in the subjects measured. Due to this finding, and to the fact that results of the two studies conflicted, it was concluded that more studies using larger numbers of subjects are needed to clarify the nature of relationships found between dietary factors, anthropometric measurements, activity levels, and laboratory measurements and serum lipid levels in dialysis patients.