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Saudi Journal of Kidney Diseases and Transplantation
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LETTER TO THE EDITOR Table of Contents   
Year : 2010  |  Volume : 21  |  Issue : 6  |  Page : 1143-1144
Serum lipase concentration in chronic hemodialysis patients


1 NPMC, Faculty of Pharmacy, Tabriz, Iran
2 Hematology and Oncology Research Centre, Faculty of Pharmacy, Tabriz, Iran
3 Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran

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Date of Web Publication4-Nov-2010
 

How to cite this article:
Mashayekhi SO, Ghandforoush-sattari M, Rahimipour A. Serum lipase concentration in chronic hemodialysis patients. Saudi J Kidney Dis Transpl 2010;21:1143-4

How to cite this URL:
Mashayekhi SO, Ghandforoush-sattari M, Rahimipour A. Serum lipase concentration in chronic hemodialysis patients. Saudi J Kidney Dis Transpl [serial online] 2010 [cited 2014 Nov 26];21:1143-4. Available from: http://www.sjkdt.org/text.asp?2010/21/6/1143/72310
To the Editor,

Many patients at end stage renal disease (ESRD) suffer from abnormalities of lipid me­tabolism. [1] These include high level of trigly­ceride (TG) and low level of high density lipoprotein cholesterol (HDLc), [2],[3] with normal level of total cholesterol (TC) and Low density lipoprotein cholesterol (LDLc). [2],[3] The elevated ratio of TC to HDLc contribute to an accele­rated development of arteriosclerosis and is one of the risk factors for coronary artery di­sease, [4] especially in ESRD [5] and chronic hemo­dialysis (HD) patients. [6] The hypertriglyceride­mia and low HDL cholesterol are thought to be caused by decreased lipoprotein lipase concen­tration. [3],[7],[8],[9],[10],[11] Another reason for increased risk of arteriosclerosis could be initiation of HD. We investigated the changes in lipoprotein lipase concentration in chronic HD patients and effect of this procedure on its concentra­tion. Demographic information included age, blood group, weight before and after dialysis, number of dialysis per week, duration of dia­lysis, laboratory results and heparin dosage. Patients with positive hepatitis B were exclu­ded from the study. Two blood samples, each 5 mL were obtained from each patient; one be­fore hemodialysis started and one at the end of hemodialysis. Lipoprotein lipase concentration was measured using Lipase kit from sigma diagnostic®, USA. [12] Forty patients, including 14 females and 26 males were enrolled to the study. A control group of healthy volunteers included 14 females and 26 males. The median age of the patients was 37.5 (15 to 64 years old), They received hemodialysis 2 -3 times a week for 3 - 4 hour each time and the mean (±SD) number of sessions was 120.0 ± 111.7 (2 to 375 times). Blood group of A with 45% and AB with 7.5% of the patients were the most and least common blood groups. Each patient received 4000 U Heparin in three divided doses (at the beginning of hemodia­lysis, 2 and 3 hours after beginning of hemo­dialysis). The patients received various numbers of drugs including iron supplements, testos­terone, vitamins, folic acid and many others according to their underlying diseases.

The mean lipoprotein lipase concentration before dialysis in females, males and all the patients was 313.2 ± 103.9, 238.8 ± 127.6 and 264.9 ± 123.8 IU/mL, respectively. The results for after dialysis samples were 460 ± 114.2, 386.2 ± 159.3 and 412 ± 148.0 IU/mL, res­pectively. There was a significant increase in lipase concentration during dialysis in all group and the subgroups (R2 = 0.665, R2 = 0.5382, R2 = 0.5765 for females, males and all the pa­tients, respectively, P < 0.0001). There was a weak but a significant relationship between lipase concentrations before and after dialysis (R2 = 0.326, P < 0.001), but no correlation with the number of dialysis sessions or age of patients.

Lipase is removed from the serum mainly by glomerular filtration and has almost a complete tubular reabsorption. [13] When there is a de­creased glomerular filtration and tubular reab­sorbtion, an increase in lipase concentration is seen. [13] During dialysis, heparin, which is used as an anticoagulant, causes the release of the enzyme into the circulating blood, [14] which could be the reason for the observed increase in lipase concentration during dialysis. Besides, the cumulative effect of heparin over the years of dialysis could be another reason for the in­creased lipase concentration. However, we failed to show any significant relationship bet­ween the number of dialysis sessions and lipase concentration. It is obvious that one of the reasons for lipid abnormalities seen in ESRD patients could be the increased lipase concentration. Therefore, we believe it is lo­gical to try and reduce lipase concentration in order to reduce the abnormalities in lipid pro­file. This may result in a decline in mortality and morbidity of cardiovascular disease in this group of patients.

 
   References Top

1.Chan MK. Lipid metabolism in renal failure. Clin Biochem 1990;23(1):61-5.  Back to cited text no. 1
    
2.Tsumura M, Kinouchi T, Ono S, Nakajima T, Komoda T. Serum lipid metabolism abnor­malities and change in lipoprotein contents in patients with advanced-stage renal disease Clin Chimica Acta 2001;314(1-2):27-37.  Back to cited text no. 2
    
3.Saland JM, Ginsberg HN. Lipoprotein meta­bolism in chronic renal insufficiency Pediatr Nephrol 2007;22(8):1095-112.  Back to cited text no. 3
    
4.Alabakovska SB, Todorova BB, Labudovic DD, Tosheska KN. LDL and HDL subclass distribution in patients with end-stage renal diseases. Clin Biochem 2002;35:211-6.  Back to cited text no. 4
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5.Lumpaopong A, Mathew AV, John E, et al. Early coronary calcification in children and young adults with end-stage renal disease. Transplant Proc 2007;39(1):37-9.  Back to cited text no. 5
    
6.Shoji T, Nishizawa Y. Plasma lipoprotein ab­normalities in hemodialysis patients-clinical implications and therapeutic guidelines. Ther Apher Dial 2006;10(4):305-15.  Back to cited text no. 6
    
7.Vaziri ND. Dyslipidemia of chronic renal failure: the nature, mechanisms, and potential conse­quences Am J Physiol Renal Physiol 2006;290 (2):F262-72.  Back to cited text no. 7
    
8.Gonzalez AI, Schreier L, Elbert A, et al. Lipo­protein alterations in hemodialysis: differences between diabetic and nondiabetic patients Metabolism 2003;52(1):116-21.  Back to cited text no. 8
    
9.Marsh JB. Lipoprotein metabolism in the nephrotic syndrome. Front Biosci 2002;7: e326-38.  Back to cited text no. 9
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10.Lee DM, Knight-Gibson C, Samuelsson O, Attman PO, Wang CS, Alaupovic P. Lipo­protein particle abnormalities and the impaired lipolysis in renal insufficiency Kidney Int 2002;61(1):209-18.  Back to cited text no. 10
    
11.Okubo M, Naito M, Nakamura M. Abnormal lipid metabolism in chronic renal failure. Nippon Rinsho 2001;59(Suppl 3):156-61.  Back to cited text no. 11
[PUBMED]    
12.Tietz NW, Fiereck EA. A specific method for serum lipase determination. Clin Chim Act 1966;13:352.  Back to cited text no. 12
    
13.Soezima A, Yomogida S, Suzuki M, et al. High sensitive photometric assay of pancreatic lipase and clinical investigation of urinary lipase in patients with various histopatholo­gical types of primary glomerulonephritis Nippon Jinzo Gakkai Shi 1990;32(10):1103-7.  Back to cited text no. 13
    
14.Nasstrom B, Olivecrona G, Olivecrona T, Stegmayr BG. Lipoprotein lipase during heparin infusion: lower activity in hemodialysis pa­tients. Scand J Clin Lab Invest 2003;63(1):45­53.  Back to cited text no. 14
    

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Correspondence Address:
Simin O Mashayekhi
NPMC, Faculty of Pharmacy, Tabriz
Iran
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PMID: 21060192

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