In uremic patients, hyperlipoproteinemia is common, but its role as a risk factor in atherogenesis remains controversial. The main abnormality appears to be diminished catabolism of lipoproteins in the face of unchanged or low hepatic synthesis. The relation of diminished catabolism to reduced postheparin lipolytic activity and selective deficiency of hepatic triglyceride lipase remains to be established. Hyperlipoproteinemia in uremic patients, most commonly of the type IV variety, responds to dietary methods (reduction of carbohydrate content, increase in P/S ratio) or pharmacological intervention. Guidelines for therapy remain controversial in view of the uncertainty about the pathogenic role of hyperlipoproteinemia in atherogenesis.