[New kidney, but a sick heart. Why many patients with renal failure and kidney transplant patients die of cardiovascular disease].

Renal insufficiency and dialysis is associated with hypertriglyceridemia caused by a decreased activity of the enzyme lipoprotein lipase. Peritoneal dialysis is further complicated by hypercholesterolemia due to an increase in the synthesis of VLDL by the liver, stimulated by a rise in glucose absorption from the peritoneal dialysate. The treatment of choice is a lipid lowering diet. If necessary, fibrates should be given in a dose adjusted to the renal failure. Hypercholesterolemia should be treated with HMG-CoA reductase inhibitors. Serum cholesterol is elevated in more than one-half of the patients with glomerular disease and protein-urea. The consequences are high rate of cardiovascular disease and accelerated progression of the glomerular disease, which can also be slowed by HMG-CoA reductase inhibitors. In 60 to 80% of the patients undergoing kidney transplantation, a cholesterol level of more than 250 mg/dl induced by corticosteroids and immunosuppressants is observed. Cardiovascular mortality is high (> 50%), with hypercholesterolemia being a major risk factor. There is evidence to show that increased cholesterol levels can shorten the survival time of transplanted kidneys. The treatment of choice is HMG-CoA reductase inhibitors which, to avoid the development of rhabdomyolysis should be used at a reduced dose when given together with cyclosporine or tacrolimus.