INCREASE IN LIPOPROTEIN-LIPASE DURING CLOFIBRATE TREATMENT OF HYPERTRIGLYCERIDEMIA IN PATIENTS ON HEMODIALYSIS

In 11 hypertriglyceridemic patients on hemodialysis, clofibrate (1 to 1.50 g per week) reduced plasma triglyceride (-40±20 per cent, P<0.001), very-low-density-lipoprotein triglyceride (-44±20 per cent, P<0.001) and very-low-density lipoprotein cholesterol (-39±25 per cent, P<0.01), and it increased high-density-lipoprotein cholesterol (82±106 per cent, P<0.005). Low pretreatment lipoprotein-lipase activity in adipose-tissue specimens and postheparin plasma increased to normal with clofibrate, whereas low hepatic triglyceride lipase activity did not change. The reduced very-low-density-lipoprotein triglyceride correlated with the increased lipoprotein-lipase activity in adipose tissue (rs = 0.792, P<0.02, n = 8) and postheparin plasma (rs = 0.851, P<0.02, n = 8), whereas increased high-density-lipoprotein cholesterol correlated with changes in this activity in adipose tissue (rs = 0.696, P<0.06) and post-heparin plasma (rs = 0.679, P<0.10). There was no correlation between changes in hepatic triglyceride lipase activity and plasma lipids during treatment. Reduced lipoprotein-lipase activity may cause hypertriglyceridemia and decreased high-density-lipoprotein cholesterol in patients on hemodialysis; clofibrate may correct these abnormalities by increasing lipoprotein-lipase activity to normal. (N Engl J Med 301:1073–1076, 1979) PATIENTS with chronic renal failure who receive maintenance hemodialysis have hypertriglyceridemia,1,2 a reduced concentration of high-density-lipoprotein cholesterol2 and a high rate of mortality from cardiovascular disease.3 In persons without uremia, the risk of coronary-heart disease correlates inversely with the plasma concentration of high-density-lipoprotein cholesterol4 and is increased in some patients with hypertriglyceridemia.5,6 The reduced high-density-lipoprotein cholesterol levels and the hypertriglyceridemia observed in patients on dialysis may be important in their premature morbidity and mortality from cardiovascular disease. Clofibrate, an effective hypolipidemic agent in persons without uremia, lowers plasma triglyceride and cholesterol levels in hypertriglyceridemic patients on dialysis when it is. © 1979, Massachusetts Medical Society. All rights reserved.