Mr. Li, who is in his forties, is an office worker. Years of diabetes have made his kidney function worse, and he is very worried about the problem of high blood lipids.
“Doctor, my triglyceride TG used to be very high. After taking the medicine for a while, the triglyceride gradually reached the standard.” Density lipoprotein cholesterol LDL-C climbs higher and higher. Why is this happening? “
“This phenomenon is called the whipping effect, and it’s pretty common in clinical practice.” Dr. disease, not only low-density lipoprotein cholesterol LDL-C To reach the standard, it is also necessary to consider that patients are more often combined with high triglycerides and low-density HDL lipoprotein cholesterol, and more active treatment is needed to the problem of mixed hyperlipidemia. However, after controlling for triglyceride TG, lipoprotein cholesterol can climb LDL-C with low density, the relationship between the two is like a whip. “
When the low-density lipoprotein cholesterol LDL-C, often referred to as “bad cholesterol”, exceeds the norm, it is quite harmful to the cardiovascular system. For patients with chronic renal failure, high triglycerides reflect these low density lipids. The particles of protein cholesterol are relatively small. Dr. Yang Zhichao said that the smaller the particles of low-density lipoprotein cholesterol can be compared to waste oil, because it is more likely to cause atherosclerotic plaque. To solve this problem, medicines of various mechanisms can be used in combination to help patients improve the quality and quantity of blood fat, so as not to lose sight of the other.
Excessive blood lipids, sadness and kidney pain!
Hyperlipidemia is an extremely common problem. Common indicators include triglycerides (TG, triglycerides), high density lipoprotein cholesterol (HDL-C, high density lipoprotein cholesterol), and low density lipoprotein cholesterol (LDL-C, low). lipoprotein cholesterol). Dr. Yang Zhichao explained that only high cholesterol is called “hypercholesterolemia”; only high triglycerides are called “hypertriglyceridemia”; if both are above the standard, it is called “mixed hyperlipidemia” disease.
Some patients with excessively high cholesterol will have “xanthomas” on the skin, with yellow or orange pimples the size of rice grains. Dr. Zhichao Yang reminded that most patients often have no obvious symptoms when their blood lipids exceed the standard and should be The blood test can only detect the danger of hyperlipidemia because there are no symptoms.
High density lipoprotein cholesterol HDL-C is a good cholesterol. Regarding lipoprotein cholesterol with low density LDL-C and triglyceride TG that exceed the standard, atherosclerosis can occur, which can cause and block vascular stenosis, and heart, kidneys and The functions of various organs are affected.
About 50% of patients with chronic kidney disease or dialysis have diabetes and are the patients with the highest cardiovascular risk. . Dr. Yang Zhichao explained that patients with kidney disease also have a more specific phenomenon, “high blood phosphorus”, which can further calcify blood fats.
Because the kidneys are not functioning properly, phosphorus in the body cannot be eliminated. As the phosphorus in the blood increases, it will stimulate the secretion of parathyroid hormone, and the increase in parathyroid hormone will release the bones calcium and phosphorus. In addition to causing osteoporosis, too much calcium and phosphorus will be deposited on the wall of the blood vessels, causing calcification of blood vessels. The existence of waste oil will further promote such fascial sclerosis and osteoporosis.
“When the kidneys are not good, the bones become softer and the blood fats get harder and harder!” Sei Dr. Yang Zhichao. High blood phosphorus will cause various complications, such as osteoporosis, fractures, and vascular calcification, which will affect the prognosis of patients with chronic kidney disease. And mortality.
Everyone is familiar with low density lipoprotein cholesterol, LDL-C, because it is not good, so it can be called cooking oil again, but low density lipoprotein cholesterol LDL-C can actually be broken down into large particles, medium particles, Dr. Yang Zhichao explained with a simple and easy-to-understand metaphor, “low-density low-density lipoprotein cholesterol (sdLDL-C, low-density low-density lipoprotein)” is common in patients with chronic kidney failure, especially patients with diabetes, that’s like a gutter. Oil, cooking oil is inferior to cooking oil and has a worse effect on the body. That is, if sdLDL-C remains in the blood for an extended period of time, it is more likely to be swallowed by macrophages to form foam cells. Damage to the cardiovascular system.
Therefore, in the treatment of hyperlipidemia, in addition to providing low-density lipoprotein-cholesterol LDL-C, it is also hoped that the low and dense low-density lipoprotein-cholesterol can be reduced.
Active treatment to prevent the whipping effect
According to treatment guidelines, recommendations for hyperlipidemia are becoming increasingly active.Dr Zhichao Yang said that for patients with chronic stage III kidney disease, it is recommended to monitor LDL-C below 70 mg / dL; for chronic kidney disease For patients undergoing dialysis in the fourth phase of the disease and having a higher cardiovascular risk, it is even recommended to fall below 55 mg / dL. More and more evidence is showing that active control of hyperlipidemia has a protective effect on patients, and a variety of medicines are currently available.
It is clinically common for patients’ lipoprotein cholesterol LDL-C to meet the standard, but the triglyceride TG is still relatively high.Dr Yang Zhichao said we will actively pursue it to reduce similar risks.
“When using triglyceride-lowering TG medications, the patient’s lipoprotein cholesterol LDL-C may increase compensatory, such as a whip,” explained Dr. block one, and the other will increase compensatory. If you want to lower the TG pressure of triglyceride, the increase of low density lipoprotein cholesterol will be more significant LDL-C. This is often counterproductive, more difficult situation. “
“Many patients with chronic kidney disease have triglyceride TG up to 300 to 400 mg / dL, or even greater than 500 mg / dL. If triglyceride TG is high, the risk of acute pancreatitis will increase and should be actively monitored. reduction of triglyceride TG, if the increase in low density lipoprotein cholesterol is not considered LDL-C, there will be some negligence. ” Zhichao Yang said, “For patients with chronic kidney disease, there are mixed types. For dyslipidemia, in order to prevent the seizure effect and to improve the quality and quantity of blood lipids, it is necessary to use drugs with different mechanisms. For example, a compound “Hypolipidemic drugs with Niacin, in addition to the statin in the tablet itself, effectively reduce LDL Niacin will not cause the rebound of TG, and it provides a good solution that can be more synergistic and additive, making blood lipid treatment more effective.”
The combined use of drugs with different mechanisms can exert complementary effects, making it easier for triglyceride TG and low-density lipoprotein cholesterol LDL-C to meet the standards, and high-density lipoprotein-cholesterol can also become HDL-C improved, which is useful for improving mixed blood lipids. The exception is very helpful. In addition, Niacin has other benefits. In addition to the anti-inflammatory and antioxidant effects, it can also inhibit the uptake of phosphorus from the digestive tract. This effect of reducing blood phosphorus is especially useful for patients with chronic kidney failure.
Prevent hyperlipidemia, focus on daily maintenance
In addition to drug treatment, lifestyle adjustments are also very important in improving hyperlipidemia. Regular exercise, weight loss, and quitting smoking can all help improve hyperlipidemia. Dr. Yang Zhichao said, “In terms of exercise, you can’t just walk, you can do resistance exercises to maintain muscle strength.”
When it comes to diet, you should drink less sugar, less processed foods, increase foods with dietary fiber, pay more attention to the quality and quantity of fats, reduce your intake of saturated fats, and not use trans fats.
Protein is an indispensable food for the human body. The recommended intake of protein for an average adult is 1.2 grams of protein per kilogram of body weight per day; if the kidney function is poor, the protein intake will be limited. Patients with chronic kidney disease stages III and IV The recommended protein intake is 0.6-0.8 grams of protein per kilogram of body weight per day; for patients undergoing dialysis treatment, the recommended protein intake is 1.2 grams of protein per kilogram of body weight per day.
Adequate intake of protein with high biological value and calories can prevent depletion of protein energy, which can lead to more complications.
Dr. Yang Zhichao added, do not listen to folk remedies or use herbs of unknown origin, in order not to aggravate the condition.
Hyperlipidemia usually has no obvious symptoms and should be detected by a blood test.
Dr. Yang Zhichao suggested that whether it is fat or thin, as long as dyslipidemia, including mixed type and simple type, requires active intervention, by adjusting lifestyle and regular medication, triglyceride TG, low density lipoprotein cholesterol LDL-C Control compliance to reduce the risk of cardiovascular disease!