Ｃｏｎｔｉｎｕｏｓ　ａｍｂｕｌａｔｏｒｙ　ｐｅｒｉｔｏｎｉａｌ　ｄｉａｌｙｓｉｓ（ＣＡＰＤ）症例における高脂血症とｐｒａｖａｓｔａｔｉｎの効果

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  • Abnormalities in continuous ambulatory peritoneal dialysis patients and the effects of pracastatin sodium.

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Continuous ambulatory peritoneal dialysis (CAPD) patients obtain parenteral glucose continuously through aperitoneal membrane. This unphysiological state may aggravate atherosclerosis. The plasma lipid levels in 43 stable CAPD patients were measured and the effects of an HMG CoA reductase inhibitor (pravastatin) on plasma total cholesterol (TC) level were evaluated in 10 patients. The lipids in the 43 patients revealed levels of 206.6±40.4mg/dl for TC, 154.9±80.1mg/dl for triglyceride (TG) and 41.6±11.81mg/dl for HDL cholesterol (HDL). Plasma apoprotein levels were 114.4±19.3mg/dl for apoprotein AI (ApoA I), 23.76±4.88mg/dl for apoprotein A II (ApoA II), 109.97±22.5mg/dl for apoprotein B (ApoB), 3.33±2.26mg/dl for apoprotein C II (ApoC II), 13.6±5.54mg/dl for apoprotein C III (C III) and 5.41±1.83mg/dl for apoprotein E (ApoE). Both ApoB/ApoA I and (TC-HDL)/HDL (Atherogenic indices) were higher than in normal controls, 0.96 and 3.95, respectively.<br>Three months after pravastatin administration, TC and TG fell from 245.5±15.4mg/dl to 190.2±16.0mg/dl and from 206.5±51.3mg/dl to 181.1±64.8mg/dl (p<0.05), respectively. LDL fell from 170.9±20.3mg/dl to 114.3±20.4mg/dl (p<0.05). On the other hand, HDL increased from 33.3±5.7mg/dl to 40.4±10.2mg/dl (p<0.05) ApoA I and ApoA II from 116±17.7mg/dl to 121.6±16.0mg/dl and from 25.4±6.0mg/dl to 28.9±5.7mg/dl (p<0.05), respectively. ApoB markedly decreased from 125.6±12.5mg/dl to 110.6±14.3mg/dl (p<0.05). ApoC II and ApoE decreased slghtly from 4.71±1.6mg/dl to 4.31±1.68mg/dl and from 5.35±1.2mg/dl to 4.92±1.3mg/dl (p<0.05), respectively. No significant change in ApoC III was observed. The concentration and pharmacological kinetics of pravastatin in CAPD patients showed a delayed degradation time (T1/2=2.8hrs). However the concentration at 24 hours after administration was less than 1.0ng/ml.<br>In conclusion, CAPD patients showed abnormal plasma lipid levels and pravastatin acts effectively to ameliorate abnormal lipid states in CAPD patients. Pravastatin might be used at the same dose as that of patients without renal failure.

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