Evaluation of dietary compliance in patients with chronic renal failure on conservative treatment: comparison of methods to assess dietary intake.
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Biomedical subjects
Publications and source records attributed to G F Guarnieri.
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Hypertriglyceridemia is often present in chronically uremic patients treated with maintenance hemodialysis and has been considered a risk factor in the accelerated development of atheroma. Muscle carnitine content is low in hemodialyzed patients. This abnormality may help to explain the myopathy and cardiomyopathy often observed in these subjects. In addition, carnitine might play a role in the hypertriglyceridemia in renal failure. Carnitine, which is necessary for fatty acid oxidation, has been recently reported to lower serum triglycerides in patients with type IV hyperlipoproteinemia. Carnitine was administered intravenously three times weekly at the end of hemodialysis in eight patients. Carnitine was given in 0.5 g doses for 8 weeks and then in 1.0 g doses for 6 additional weeks. There was a significant decrease in serum triglycerides at the end of treatment. In contrast, serum lipids in eight hemodialysis patients receiving placebo did not change significantly. Carnitine administration does not cause any side effect except some euphoria. These results suggest that carnitine may be effective in the treatment of hypertriglyceridemia in dialysis patients.
A fingertip biopsy was made in 18 patients affected by chronic uremia, in order to study the histangic changes. Partial occlusion of the blocking devices, capillary dilation and regressive changes in sensitive corpuscles, especially in Vater-Pacinian ones, were observed. The incidence of dermal necrosis and of calcium deposits was also high.
The metabolic effects of an acute acetate load have been investigated in chronic uremic patients and in controls. The decay rate of blood acetate levels was significantly lower in patients than in controls. Higher levels of blood acetoacetate and 2-oxoglutarate and plasma triglycerides were observed in the patients after the load. No difference was detectable in plasma levels of unesterified fatty acids and cholesterol between the two groups of subjects. Acetate oxidation in citric acid cycle may be reduced in uremia owing to a lack of coenzyme A. These observations raise the possibility that chronic acetate administration with the dialysate induces hypertriglyceridemia and accelerates the development of atherosclerosis in hemodialysis patients.
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High plasma concentrations of triglycerides and low plasma concentrations of esterified cholesterol and lysolecithin, with an impaired rate of VLDL and LDL catabolism, have been reported in chronic uremic patients. An important contribution to these abnormalitites might be an impaired activity of the (LCAT). Serum LCAT activity and cholesteryl ester clearance were determined in 11 patients with chronic renal failure and in 10 controls. LCAT activity was determined by using the serum of each patient both as a source of enzyme and as a substrate ("intrinsic" activity) and was compared with the activity determined on a standard substrate ("extrinsic activity), so as to ascertain the presence of inhibitory factors in the patients' sera. Both activityes have been found to be significantly (P less than 0.01) lower in chronic uremic patients than in controls. The cholesteryl ester clearance apparently did not respond to the stimulatory effect of hypertriglyceridemia, as observed in other cases of dislipoproteinemias. The parallel decrease of both enzyme activities makes it unlikely that it is due to the presence of "uremic toxins" inhibiting the enzyme activity. LCAT synthesis in the liver is probably reduced in chronic uremia. These results suggest that in chronic uremia the VLDL fail to cooperate in their own catabolism.
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