Since epidemiologic studies show that the risk of clinically evident atherosclerosis correlates negatively with concentrations of high-density lipoprotein, we sought to determine whether patients on chronic hemodialysis or recipients of renal transplants had alterations in this lipoprotein similar to those described in other disorders associated with accelerated forms of atherosclerosis. High-density-lipoprotein cholesterol concentrations in both groups of renal patients were significantly lower than control values (P less than 0.01), and their ratios of low-density-lipoprotein to high-density-lipoprotein cholesterol were significantly higher (P less than 0.01) than those observed in both randomly selected controls and in controls matched for plasma lipid levels (control, 2.4 +/- 1.2, dialysis, 3.7 +/- 2.1, and transplant, 5.4 +/- 2.3 mg per 100 ml [mean +/- S.D.]) if, as experimental evidence suggests, high-density lipoprotein retards the development of atherosclerosis, and low-density lipoprotein has opposite effects, the higher ratio of low-density-lipoprotein to high-density-lipoprotein cholesterol found in chronic-dialysis and renal-transplant patients may be related to their premature morbidity and mortality from cardiovascular causes.
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