Effect of Diabetes Mellitus and End-Stage Renal Disease on HDL Metabolism

  • M. H. Tan
Part of the Advances in Experimetal Medicine and Biology book series (AEMB, volume 201)


Different types of diabetes mellitus have different effects on high density lipoprotein (HDL) metabolism. Impaired glucose tolerance may be associated with no change or a slight decrease in HDL cholesterol. Type I diabetes may have normal or elevated HDL cholesterol levels. This HDL elevation may be due to an increase in HDL2 or HDL3. Apo A-I/Apo A-II ratio is also higher in these diabetics. Type II diabetics may have normal or low HDL cholesterol levels as well as normal or decreased Apo A-I levels. In gestational diabetics, the mean HDL cholesterol is lower than controls. Dietary therapy resulting in > 10% weight loss in obese diabetics leads to an increase in their HDL-cholesterol levels, although the effect on the latter is controversial. Intensive insulin therapy (for 2–3 weeks) increases serum apo A-I and HDL-cholesterol levels.

End-stage renal disease also affects HDL metabolism. In general, patients with this disorder have a decrease of cholesterol and an increase in triglyceride in their HDL. There is an increase in apo E and a decrease in apo CII in their HDL. Apo A-I levels are unaffected whereas apo A-II levels are decreased. Renal transplant patients may have low, normal or high HDL cholesterol and normal or high apo-I levels. In non-diabetic, normotriglyceridemic patients peritoneal dialysis increases their HDL-cholesterol. In non-diabetic hypertriglyceridemic and diabetic patients, peritoneal dialysis causes no change in their HDL-cholesterol. Hemodialysis can increase HDL-cholesterol levels in these patients.

In contrast to uremic humans, uremic rats have elevated HDL-cholesterol and this accounts for most of the increase in their serum cholesterol. The dialysed and undialysed plasma of these uremic rats have inhibitory action on hepatic lipase activity.

Diabetes mellitus and uremia due to end-stage renal disease are common metabolic disorders which can affect high density lipoprotein (HDL) metabolism. In this paper the many changes in HDL metabolism associated with these syndromes will be presented.


Renal Transplant Patient Intensive Insulin Therapy High Density Lipoprotein Cholesterol Level Serum High Density Lipoprotein Cholesterol Hepatic Lipase Activity 
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Copyright information

© Springer Science+Business Media New York 1986

Authors and Affiliations

  • M. H. Tan
    • 1
  1. 1.Division of Endocrinology & Metabolism Department of MedicineDalhousie UniversityHalifaxCanada

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