Low-Flow Polysulfone Hemodialysis Alters Lipoprotein Parameters, Paraoxonase Activity and in Vitro Incorporation of Phospholipids

Abstract

End stage-renal-disease (ESRD) is associated with dyslipidemia and premature atherosclerosis. The study evaluates the effect of hemodialysis (HD) on HDL-remodeling between pre- and post-HD. Was conducted a cross-sectional study with 50 ESRD male patients, undergoing HD at Ana Neri Hospital, Salvador, Brazil. All individuals were on HD for at least 3 months, into a three sessions protocol for 3 - 4 hours per week, with a polysulfone low-flow basic-dialyzing-membrane and unfractionated-heparin. HDL Phospholipid-incorporation was measured by 14C-PL-scintillation-counting, expressed as %14C-PL/mL/hour. Paraoxonase (PON-1) activity was measured by spectrophotometry using paraoxon as substrate. Cardiovascular risk ratios and atherogenic index of plasma were calculated. Total cholesterol, HDL-C and non-HDL-C increased at post-HD on all age groups, but without triglycerides (TG) changes. TG/HDL-C decreased in 30 - 39 and 40 - 49 year (y) at post-HD (p 60 y, after HD (p 60 (p 60 y, at post-HD (p 60 y, both at pre- (r = 0.63; p = 0.029) and post-HD (r = 0.65; p = 0.022). PON-1 activity increased at pre- (59 ± 30) and post-HD (73 ± 38) in 50 - 59 y (p 60 y (p < 0.05), when compared to pre- and post-HD. ESRD patients undergoing HD shows important changes on lipid-profile, PON-1-activity, cardiac risk ratios and HDL-remodeling. These results demonstrate the influence of HD with a polysulfone low-flow basic-dialyzing-membrane and unfractionated-heparin on lipoprotein metabolism.