Patient description: A 54-year-old obese woman admitted to the emergency department with abdominal pain that started 4 days ago with nausea and vomiting. The epigastric pain radiates to the right upper quadrant, getting worse after eating fatty food. The patient experienced similar pain twice in the past year. Her past medical history is remarkable for hypercholesterolemia and 2 NVDs. She has 2 children, and she is menopausal. She does not smoke, drink alcohol, or use illicit drugs. She is mildly febrile. Her BP is 150/85, HR 115, RR 15, T 38.2, SpO2 98% on RA. She is an obese woman with no acute distress. On palpation, she experiences epigastric tenderness and tenderness in the right upper quadrant without rebound. Bowel sounds are normal. Laboratory analysis is remarkable for elevated ESR and leukocytosis with a left shift. The ultrasound revealed several gallstones, biliary sludge and CBD stones. The smallest stone is 14mm.

Clinical trial eligibility criteria: eligible ages (years): 18.0-75.0,  End-stage Renal Disease Male and females, 18-75 years of age. 2. Chronic renal failure with hemodialysis 3x/week for at least 6 months and adequate dialysis as judged by a nephrologist who is not a study investigator. 3. Fasting TG <600 mg/dl, LDL cholesterol <190 mg/dl (off lipid-lowering medication) 4. Willing and able to change Renagel, a noncalcemic phosphate binder (poly[allylamine hydrochloride]) which has LDL-lowering effects, to the same amount of another phosphate binder for 1 month prior to the screening visit until the completion of the study. 5. Willing and able to temporarily stop Sensipar (cinacalcet) for 1 week before the study admission until completion of the study (a total of ~2 weeks). 6. Willing and able to stop ASA (except low dose ASA in patients with vascular disease), NSAID, fish oil, psyllium, other nonprescribed vitamins/supplements for 1 week prior to study until completion of study. 7. Willing and able to sign an informed consent. 8. Willing to refrain from participation in an investigational drug study for the duration of the study  Diabetes (fasting blood sugar >126 twice or an abnormal 2 hour OGTT) 2. Unstable clinical condition, including acute febrile illness within 1 month of admission 3. Chronic infection, including hepatitis and HIV infection 4. Gastrointestinal disease resulting in significant GI dysfunction or malabsorption 5. Lipid-lowering medication 6. Mean systolic blood pressure >180 or diastolic pressure >110 taken immediately before 6 dialysis treatments over the 2 weeks before the screening visit 7/15/2008 Form version 6/13/2005 #LHU-0471-0407 Page 8of 16f 7. BMI >35 (markedly obese) 8. Hemoglobin <10.0 9. Prednisone, estrogen/progesterone, other steroids, Synthroid, endocrine disease 10. Coumadin and an INR >1.5 11. Cigarette smoking >1/2 pack/day 12. Abuse of ethanol (greater than 2 drinks/day) or illicit drugs 13. If female, pregnant or breast feeding 14. Participation in a study of an investigational drug during the 30 days preceding the start of the screening period 15. Have any other condition, which in the opinion of the investigator, should prohibit the participation in the study Healthy Controls: 1. Male and females, 18-75 years of age 2. LDL <160 mg/dl, HDL-C >30 mg/dl, TG <250 mg/dl 3. Willing and able to stop ASA, NSAID, fish oil, psyllium, other vitamins/supplements for 1 week prior to study until completion of study 4. Willing and able to sign an informed consent 5. Willing to refrain from participation in an investigational drug study for the duration of the study Systemic illnesses, including diabetes (FBS >126 twice or abnormal OGTT), cardiovascular disease, hepatitis, endocrine disease, HIV infection. 2. Prescription medications, including contraceptives. 3. Acute febrile illness within 1 month of admission. 4. BMI >35 (markedly obese) or>10% below maximum weight. 5. Weight change of >10% usual weight in the previous 6 months. 6. Blood pressure >140/90. 7. HB <11 female, <12 male. 8. CRP >5.0 on 2 occasions. 7/15/2008 Form version 6/13/2005 #LHU-0471-0407 Page 9of 16f 9. Abuse of ethanol (greater than 2 drinks/day) or illicit drugs. 10. Cigarette smoking >1/2 pack/day. 11. Unusual diet or extreme physical activity (e.g. marathon runner). 12. If female, pregnant or breast feeding. 13. Participation in a study of an investigational drug during the 30 days preceding the start of the screening period. 14. Have any other condition, which in the opinion of the investigator, should prohibit the participation in the study