BACKGROUND AND OBJECTIVES: Dialysis patients show "reverse causality" between serum cholesterol and mortality. No previous studies clearly separated the risk of incident cardiovascular disease (CVD) and the risk of death or fatality after such events. We tested a hypothesis that dyslipidemia increases the risk of incident atherosclerotic CVD and that protein energy wasting (PEW) increases the risk of fatality after CVD events in hemodialysis patients. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: This was an observational cohort study in 45,390 hemodialysis patients without previous history of myocardial infarction (MI), cerebral infarction (CI), or cerebral bleeding (CB) at the end of 2003, extracted from a nationwide dialysis registry in Japan. Outcome measures were new onsets of MI, CI, CB, and death in 1 year. RESULTS: The incidence rates of MI, CI, and CB were 1.43, 2.53, and 1.01 per 100 person-years, and death rates after these events were 0.23, 0.21, and 0.29 per 100 person-years, respectively. By multivariate logistic regression analysis, incident MI was positively associated with non-HDL cholesterol (non-HDL-C) and inversely with HDL cholesterol (HDL-C). Incident CI was positively associated with non-HDL-C, whereas CB was not significantly associated with these lipid parameters. Among the patients who had new MI, CI, and/or CB, death risk was not associated with HDL-C or non-HDL-C, but with higher age, lower body mass index, and higher C-reactive protein levels. CONCLUSIONS: In this hemodialysis cohort, dyslipidemia was associated with increased risk of incident atherosclerotic CVD, and protein energy wasting/inflammation with increased risk of death after CVD events.
BACKGROUND AND OBJECTIVES: Dialysis patients show "reverse causality" between serum cholesterol and mortality. No previous studies clearly separated the risk of incident cardiovascular disease (CVD) and the risk of death or fatality after such events. We tested a hypothesis that dyslipidemia increases the risk of incident atherosclerotic CVD and that protein energy wasting (PEW) increases the risk of fatality after CVD events in hemodialysis patients. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: This was an observational cohort study in 45,390 hemodialysis patients without previous history of myocardial infarction (MI), cerebral infarction (CI), or cerebral bleeding (CB) at the end of 2003, extracted from a nationwide dialysis registry in Japan. Outcome measures were new onsets of MI, CI, CB, and death in 1 year. RESULTS: The incidence rates of MI, CI, and CB were 1.43, 2.53, and 1.01 per 100 person-years, and death rates after these events were 0.23, 0.21, and 0.29 per 100 person-years, respectively. By multivariate logistic regression analysis, incident MI was positively associated with non-HDL cholesterol (non-HDL-C) and inversely with HDL cholesterol (HDL-C). Incident CI was positively associated with non-HDL-C, whereas CB was not significantly associated with these lipid parameters. Among the patients who had new MI, CI, and/or CB, death risk was not associated with HDL-C or non-HDL-C, but with higher age, lower body mass index, and higher C-reactive protein levels. CONCLUSIONS: In this hemodialysis cohort, dyslipidemia was associated with increased risk of incident atherosclerotic CVD, and protein energy wasting/inflammation with increased risk of death after CVD events.
Authors: George A Kaysen; Joel A Dubin; Hans-Georg Müller; Laura Rosales; Nathan W Levin; William E Mitch Journal: Kidney Int Date: 2004-04 Impact factor: 10.612
Authors: Yongmei Liu; Josef Coresh; Joseph A Eustace; J Craig Longenecker; Bernard Jaar; Nancy E Fink; Russell P Tracy; Neil R Powe; Michael J Klag Journal: JAMA Date: 2004-01-28 Impact factor: 56.272
Authors: Weiquan Lu; Helaine E Resnick; Kathleen A Jablonski; Kristina L Jones; Arvind K Jain; Wm James Howard; David C Robbins; Barbara V Howard Journal: Diabetes Care Date: 2003-01 Impact factor: 19.112
Authors: George A Kaysen; Lorien S Dalrymple; Barbara Grimes; Glenn M Chertow; John Kornak; Kirsten L Johansen Journal: Nephrol Dial Transplant Date: 2013-09-05 Impact factor: 5.992