Hypertriglyceridemia in chronic nonnephrotic renal failure

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Abstract
Elevated plasma triglyceride (TG) levels were present in 11 out of 14 undialyzed (U) patients and 17 out of 25 hemodialyzed (H) uremic patients with chronic nonnephrotic renal failure (CRF). Plasma postheparin lipolytic activity (PHLA) was strikingly reduced in 21 out of 22 patients examined in the CRF groups under study. After hemodialysis, TG fell to normal simultaneously with a significant increase in PHLA. TG and PHLA returned to predialysis values 12 to 36 hr after hemodialysis. Metabolic improvement occasioned by dialysis did not seem to be responsible for TG and PHLA changes as patients undergoing either hemodialysis on regional heparinization or peritoneal dialysis (PD) who had similar metabolic improvement showed no change in TG or PHLA. Thus, the role of heparin was investigated. The iv injection of the standard dose of heparin used for PHLA determinations produced no significant change in TG in two CRF patients as compared with a 60% drop in two normal subjects. In contrast, the iv injection of 40 mg heparin into two CRF patients resulted in more than a 50% fall in TG, accompanied by a significant rise in PHLA. No evidence for PHLA inhibitors could be found in five CRF patients tested. Our data indicate that in CRF, a quantitatively subnormal PHLA response to heparin exists and that abnormal TG clearance mechanisms may play a major role in CRF hypertriglyceridemia. In addition, sufficient caloric intake and a good nutritional status resulting in adequate TG synthesis seem to be necessary for the hypertriglyceridemia to be evident. Of the CRF patients who had normal TG levels, 75% were undernourished as compared with only 6% among the CRF patients with hypertriglyceridemia. Whatever the basic mechanisms involved in the TG and PHLA abnormalities reported here, chronic renal insufficiency is a primary component, as in one patient with a successful 7-year kidney transplant, restoration of renal function was accompanied by normal PHLA and TG levels.