I have a patient who is on PD for 5 years now. She is dislipemic, with high levels of tryglicerides and colesterol. She can not tolerate fibrates (epigastric reasons)and with statins, her hepatic enzymes goes up. I have to use daily hypertonic bags in her prescription because she is anuric. In your oppinion, is she a candidate for a permanent switch to HD?

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marcia, F, Doctor/MD from Rio de Janeiro, Brazil asked
I have a patient who is on PD for 5 years now. She is dislipemic, with high levels of tryglicerides and colesterol. She can not tolerate fibrates (epigastric reasons)and with statins, her hepatic enzymes goes up. I have to use daily hypertonic bags in her prescription because she is anuric. In your oppinion, is she a candidate for a permanent switch to HD?

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In my opinion, the answer is ‘no’. First of all, both patients on PD and HD are prone to be dyslipidemic. Transferring to HD would be not helpful for the patient with dyslipdemia. Secondly, although hyperlipidemia is a risk factor of cardiovascular disease in general population, its relationship with CV outcome is not linear, but ‘U-shaped’ in dialysis population. The hyperlipidemia is actually reflecting a good nutrition status in some extents. The final impact of hyperlipidemia on a individual patient depends on the balance of advantages and disadvantages. Thirdly, this patient could do more exercise, and try to use other medication, like VitE, omega-3, et al to treat the dislipidemic. She also needs to be strengthened on sodium and water restriction education avoiding from too much hypertonic bags.
Anyway, any therapy will have its own limitation. Changing a modality may be better, or worse, and thus is always a challenge for doctors.

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