ASN95 Hot Topic: Cholesterol and progression of renal disease

Based on animal experiments, it has been postulated that hyperlipidemia may contribute to the development of renal injury in patients with essential hypertension or with primary renal diseases. Support for this hypothesis in humans was presented by Klag et al (84/393) and by Samuelsson et al. (83/402 and 85/402). Using the MRFIT data base and the HCFA ESRD registry, Klag et al. showed that, over an average 16 year follow up, serum cholesterol in 332,544 subjects screened for the MRFIT trial (all men) had a graded relationship to the development of ESRD. Compared to men with serum cholesterol < 200 mg/dl, the relative risk of ESRD in men with cholesterol greater than 240 mg/dl was 1.43 (confidence interval 1.2, 1.7). In 43 patients with chronic GN, Samuelsson et al. found serum cholesterol, LDL-cholesterol, and LDL/HDL ratio to correlate with higher rates of progression of renal failure. In diabetics, higher rates of progression were associated with increased LDL and LDL/HDL ratio. Taken together, these studies suggest that lowering elevated serum cholesterol may preserve renal function in hypertension, chronic GN and diabetic nephropathy. (Vardaman M. Buckalew, Bowman Grey School of Medicine, Winston-Salem, NC)

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