Balaskas EV, Bamihas GI, Karamouzis M, Sioulis A,
Tourkantonis A
(1) Gemfibrozil, (2) pravastatin, and (3) omega-3
fatty acid treatment of dyslipidemia in CAPD patients 3
abstracts
XVIth Annual CAPD Conference
Perit Dial Int Suppl 2
(Feb) 16:S57,57,58 1996
In these three abstracts the authors investigate the use of different lipid-
lowering agents in the
CAPD population. Hyperlipidemia, and in particular hypertriglyceridemia,
have been a consistent
source of concern in CAPD populations.
Pravastatin 20 mg daily was used in 17 patients with undefined diet-resistant
hypercholesterolemia.
Treatment was for 6-18 months and two patients had the treatment stopped
because of increased CK
values. Overall the agent was very effective with approximately 40%
decreases in cholesterol, 45%
decreases in LDL-C, and 20-30% decreases in triglycerides. HDL-C increased
by 14-22% and the Apo
A1/Apo B ratio increased to 38%.
Gemfibrozil, a fibric acid derivative, 900 mg daily, was used in 19 patients
with diet-resistant
hypertriglyceridemia of undefined severity. Treatment was for 6-12 months
and it was stopped in two
patients because of elevated CK levels, and in one patient because of an
allergic reaction. The
intervention was effective in that triglycerides fell by 35-55% and HDL-C was
increased by 14-18%,
while the Apo A1/Apo B ratio increased 30%. Total cholesterol decreased by
under 10% but this was
not significant and not necessarily elevated in the first place.
Omega-3 fatty acids [5 ml dose containing 790 mg of EPA and 527 mg of DHA
twice daily] was given to
10 patients with diet-resistant hyperlipidemia of undefined severity.
Treatment was for 3-6 months
and there were no withdrawals, complications or side effects. Total
cholesterol fell 15-18% and
triglycerides fell 39-47%. HDL rose 14-17%.
In summary, all three interventions were very effective. For isolated
hypertriglyceridemia, Omega-3
fatty acids and gemfibrozil appeared marginally superior to pravastatin, and
the Omega-3 fatty acids
had the least side effects. For hypercholesterolemia, however, pravastatin
was easily the most
efficacious and had a very beneficial effect on the total lipid profile
without significant side
effects.
Comment: These studies, which confirm findings for non-dialysis
patients, are helpful in that
they clarify which agents may be effective in which scenario. The studies
are limited, however, in
that there are no controls and in that follow-up is relatively short. The
lack of serious side
effects is encouraging. A question remains, however, as to what the
indications are for
pharmacological intervention in diet-resistant hyperlipidemia in PD patients.
We are all aware of
the implications of high lipid levels in the general population, but we have
also discovered in
recent years that low lipid levels are a greater risk than high lipid levels
in the dialysis
population, presumably because of their association with malnutrition. This
story needs to be
teased out much further before appropriate strategies become clearly
apparent.
(Peter G. Blake, M.D.)
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XVIth Annual CAPD Conference
CRF by problem area :
Lipids