Issue: 2008 > February > review

Cholesterol in end-stage renal disease: the good, the bad or the ugly?

S.H.A. Diepeveen, J.F.M. Wetzels, H.J.G. Bilo, L.J.H. van Tits, A.F.H. Stalenhoef


The incidence of cardiovascular disease is markedly
increased in patients with end-stage renal disease
(ESRD). High serum cholesterol is widely recognised as
a cardiovascular risk factor in the general population.
However, in patients with ESRD high concentrations of
cholesterol are associated with a better survival. This reverse epidemiology is, amongst others, caused by confounding due to malnutrition and chronic inflammation. In this population, treatment with statins to lower the serum cholesterol remains a matter of debate. In ESRD, LDL cholesterol is modified by increased oxidative stress. These altered LDL particles play a pivotal role in the development of atherosclerosis. Treatment with the antioxidant vitamin
E has not equivocally been shown to be beneficial in this
population. This review tries to put data from literature on dyslipidaemia and oxidative stress in ESRD in perspective.