Cheol Ho Park1, Ea Wha Kang2, Jung Tak Park1, Seung Hyeok Han1, Tae-Hyun Yoo1, Shin-Wook Kang3, Tae Ik Chang4. 1. Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea. 2. Department of Internal Medicine, National Health Insurance Service Medical Center, Ilsan Hospital, Goyang-si, Gyeonggi-do, Republic of Korea. 3. Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea; Brain Korea 21 PLUS for Medical Science, Severance Biomedical Science Institute, Yonsei University, Seoul, Republic of Korea. 4. Department of Internal Medicine, National Health Insurance Service Medical Center, Ilsan Hospital, Goyang-si, Gyeonggi-do, Republic of Korea. Electronic address: kidneyjang@gmail.com.
Abstract
BACKGROUND: The association of dyslipidemia with mortality has not been fully evaluated in patients on peritoneal dialysis (PD). Moreover, changes in lipids levels over time and associated death risk have not yet been studied in this population. OBJECTIVE: We studied the association of time-updated serum lipid concentrations with all-cause and cardiovascular (CV) mortalities in a 10-year cohort of 749 incident PD patients. METHODS: Association was assessed using time-varying Cox proportional hazard regression models with adjustment for multiple variables including statin therapy. RESULTS: During a median follow-up of 36 (interquartile range, 21-61) months, 273 all-cause and 107 CV deaths occurred. Compared with those with total cholesterol (TC) of 180 to <210 or low-density lipoprotein cholesterol (LDL-C) of 100 to <130 mg/dL, hazard ratios (95% confidence interval) of the lowest TC (<150 mg/dL) and LDL-C (<70 mg/dL) were 2.32 (1.61-3.35) and 2.02 (1.45-2.83) for all-cause mortality and 1.87 (1.04-3.37) and 1.92 (1.13-3.26) for CV mortality, respectively. Lower triglyceride (<100 mg/dL) and high-density lipoprotein cholesterol (<30 mg/dL) levels were associated with higher all-cause mortality (1.66 [1.11-2.47] and 1.57 [1.08-2.29]) but not with CV mortality. CONCLUSIONS: Contrary to the general population, lower TC and LDL-C levels over time were significantly associated with both worse survival and increased CV mortality in incident PD patients. Although lower triglyceride and high-density lipoprotein cholesterol concentrations were associated with significantly higher all-cause mortality, they failed to show any clear association with CV mortality. The underlying mechanisms responsible for this apparent paradox await further investigations.
BACKGROUND: The association of dyslipidemia with mortality has not been fully evaluated in patients on peritoneal dialysis (PD). Moreover, changes in lipids levels over time and associated death risk have not yet been studied in this population. OBJECTIVE: We studied the association of time-updated serum lipid concentrations with all-cause and cardiovascular (CV) mortalities in a 10-year cohort of 749 incident PDpatients. METHODS: Association was assessed using time-varying Cox proportional hazard regression models with adjustment for multiple variables including statin therapy. RESULTS: During a median follow-up of 36 (interquartile range, 21-61) months, 273 all-cause and 107 CV deaths occurred. Compared with those with total cholesterol (TC) of 180 to <210 or low-density lipoprotein cholesterol (LDL-C) of 100 to <130 mg/dL, hazard ratios (95% confidence interval) of the lowest TC (<150 mg/dL) and LDL-C (<70 mg/dL) were 2.32 (1.61-3.35) and 2.02 (1.45-2.83) for all-cause mortality and 1.87 (1.04-3.37) and 1.92 (1.13-3.26) for CV mortality, respectively. Lower triglyceride (<100 mg/dL) and high-density lipoprotein cholesterol (<30 mg/dL) levels were associated with higher all-cause mortality (1.66 [1.11-2.47] and 1.57 [1.08-2.29]) but not with CV mortality. CONCLUSIONS: Contrary to the general population, lower TC and LDL-C levels over time were significantly associated with both worse survival and increased CV mortality in incident PDpatients. Although lower triglyceride and high-density lipoprotein cholesterol concentrations were associated with significantly higher all-cause mortality, they failed to show any clear association with CV mortality. The underlying mechanisms responsible for this apparent paradox await further investigations.
Authors: George A Kaysen; Xiaoling Ye; Jochen G Raimann; Yuedong Wang; Alice Topping; Len A Usvyat; Stefano Stuard; Bernard Canaud; Frank M van der Sande; Jeroen P Kooman; Peter Kotanko Journal: J Lipid Res Date: 2018-06-12 Impact factor: 5.922