[Fat and Renal Failure--therapeutic Aspects]

There is current debate as to whether or not the hyperlipidaemia seen in patients (1) with chronic renal insufficiency, (2) on regular dialysis treatment and (3) after successful renal transplantation should be specifically treated. The reduced HDL cholesterol fraction suggests that the risk of cardiovascular complications may be increased. Therapeutic possibilities include increased physical exercise and a reduction of carbohydrate intake. If these measures fail, then treatment with clofibrate or bezafibrate should be considered. The recommended dosage of clofibrate is 1.0-1.5 g/week (with CPK-control), and of bezafibrate is 400-500 mg/week in patients with chronic renal insufficiency (creatinin-clearance below 20 ml/min). In patients on regular dialysis treatment plasma lipids are reduced by adding carnitine. Most investigators believe that a specific therapy of the hypercholesterolaemia and hypertriglyceridaemia of patients with nephrotic syndrome is not necessary since the disturbances in fat metabolism are associated with an increased levels of HDL-cholesterol. With remission of the nephrotic syndrome an improvement of the hyperlipoproteinaemia is observed. If patients with acute renal failure are under parenteral nutrition fat infusion is recommended once per week to avoid a deficiency of essential fatty acids which is augmented by daily dialysis therapy.