Effect of lipid lowering therapy on LDL-S-homocysteinilation status in Chronic Kidney Disease patients

Chronic Kidney Disease (CKD) is currently recognized as an important global population health problem. Dyslipidemia associated with CKD contributes to the inflammatory response in renal failure. The dyslipidemia control through lipid lowering therapy is one of the targets for the treatment of CKD. The aim of this study is to evaluate the effect of hypolipidemic drugs on the LDL thiolation in proteinuric nefropatic patients during lipid lowering therapy. We enrolled thirty CKD patients randomized to receive three different hypolipidemic regimens: simvastatin alone (40 mg/day) or ezetimibe/ simvastatin combined therapy (10/20 or 10/40 mg/day). LMW thiols in their reduced and total form, oxidative stress indices as malondialdehyde and allantoin/uric acid ratio were evaluated. LDL thiolation decreased in all treated patients, but a greater efficacy was attained from a combined therapy with a higher simvastatin dose. In particular, in this patients group the reduction of apoB-Hcy was greater than 40%. The concomitant decrease of the oxidative stress indices during the therapy brings to the hypothesis that decreased levels of protein bound thiols may be a consequence of oxidative stress improvement. Therefore, among the several beneficial effects described for lipid lowering drugs we also propose their ability to reduce the quantity of LDL linked homocysteine thus decreasing not only LDL levels but also LDL atherogenicity.