Lipid disorders - the comparison between general population and haemodialyzed patients. Will the Oral Fat Tolerance Test improve the diagnostic?

The cardiovascular events are frequent complications in chronic kidney disease (CKD). In the general population the risk factors of CV disease are well established and divided into two groups: non-modifiable, and modifiable. The best-known modifiable risk factors leading to the atherosclerotic plaque formation are lipid disorders. In comparison, an association between serum lipid profile in haemodialyzed patients and cardiovascular mortality is more complex and still unclear. Furthermore, it is important to note that recent studies suggest an inverse relationship between lipid disorders and CV mortality in a haemodialyzed population called 'reverse epidemiology'. The disparity between the general and haemodialyzed populations may be supported by the fact that the haemodialysis process itself contributes to the development of dyslipidaemia. Moreover, the chronic kidney disease is associated with metabolic abnormalities which can increase the risk of CVD occurrence. It is estimated that one-third of the patients on haemodialysis have lipid profile abnormalities, the most common one is hypertriglyceridemia. The assessment of the lipid profile has so far been performed in a fasting and non-fasting (postprandial) state, but both of these methods have some limitations. This review evaluates the current knowledge about lipid profile abnormalities in haemodialyzed patients and discusses a potential role of the Oral Fat Tolerance Test (OFTT) as a new tool in clinical practice that may improve the diagnosis of postprandial hypertriglyceridemia.