Tae Ik Chang1, Elani Streja2, Melissa Soohoo2, Gang Jee Ko3, Connie M Rhee2, Csaba P Kovesdy4, Moti L Kashyap5, Nosratola D Vaziri2, Kamyar Kalantar-Zadeh6, Hamid Moradi7. 1. Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, School of Medicine, Orange, CA, USA; Department of Internal Medicine, National Health Insurance Service Medical Center, Ilsan Hospital, Goyangshi, Gyeonggi-do, Republic of Korea. 2. Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, School of Medicine, Orange, CA, USA. 3. Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, School of Medicine, Orange, CA, USA; Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea. 4. Division of Nephrology, University of Tennessee Health Science Center, Memphis TN, USA; Nephrology Section, Memphis Veterans Affairs Medical Center, Memphis TN, USA. 5. Atherosclerosis Research Center, Gerontology Section, Geriatric, Rehabilitation Medicine and Extended Care Health Care Group, Veterans Affairs Medical Center, Long Beach, CA, USA; Department of Medicine, University of California, Irvine, Orange, CA, USA. 6. Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, School of Medicine, Orange, CA, USA; Department of Medicine, University of California, Irvine, Orange, CA, USA. 7. Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, School of Medicine, Orange, CA, USA; Department of Medicine, University of California, Irvine, Orange, CA, USA. Electronic address: hamid.moradi@va.gov.
Abstract
BACKGROUND: Elevated serum high-density lipoprotein cholesterol (HDL-C) has not been associated with better cardiovascular (CV) and all-cause mortality in hemodialysis patients. However, the association between change in HDL over time and mortality has not been fully examined. OBJECTIVE: In a nationally representative cohort of incident hemodialysis patients who had available HDL data at baseline and 6 months after dialysis initiation, we studied the association of change in HDL-C during the first 6 months of dialysis with all-cause and CV mortality. METHODS: Associations between HDL-C change and mortality were determined in Cox proportional hazard regression models with adjustment for multiple variables. RESULTS: In case-mix models, there was a J-shaped association between change in HDL-C and mortality, such that quartiles 1 (<-5 mg/dL) and 4 (≥7 mg/dL) were each associated with higher all-cause (hazard ratio, 1.32 [95% confidence interval, 1.21-1.45] and 1.09 [1.01-1.18]) and CV (1.28 [1.06-1.55] and 1.23 [1.04-1.45]) death risk, respectively. In fully adjusted models that included indices of malnutrition and inflammation, the higher death risk observed in the lowest quartile was attenuated, whereas the highest quartile continued to demonstrate significantly higher all-cause (1.11 [1.02-1.20]) and CV mortality (1.15 [1.00-1.32]). These associations persisted across various subgroups. CONCLUSIONS: Although malnutrition and inflammation may explain the increased risk for mortality in patients with decreasing serum HDL-C concentrations over time, these indices do not mitigate the elevated risk in patients with rising serum HDL-C. We found that increasing serum HDL-C over time is paradoxically associated with worse outcomes in incident hemodialysis patients. Published by Elsevier Inc.
BACKGROUND: Elevated serum high-density lipoprotein cholesterol (HDL-C) has not been associated with better cardiovascular (CV) and all-cause mortality in hemodialysis patients. However, the association between change in HDL over time and mortality has not been fully examined. OBJECTIVE: In a nationally representative cohort of incident hemodialysis patients who had available HDL data at baseline and 6 months after dialysis initiation, we studied the association of change in HDL-C during the first 6 months of dialysis with all-cause and CV mortality. METHODS: Associations between HDL-C change and mortality were determined in Cox proportional hazard regression models with adjustment for multiple variables. RESULTS: In case-mix models, there was a J-shaped association between change in HDL-C and mortality, such that quartiles 1 (<-5 mg/dL) and 4 (≥7 mg/dL) were each associated with higher all-cause (hazard ratio, 1.32 [95% confidence interval, 1.21-1.45] and 1.09 [1.01-1.18]) and CV (1.28 [1.06-1.55] and 1.23 [1.04-1.45]) death risk, respectively. In fully adjusted models that included indices of malnutrition and inflammation, the higher death risk observed in the lowest quartile was attenuated, whereas the highest quartile continued to demonstrate significantly higher all-cause (1.11 [1.02-1.20]) and CV mortality (1.15 [1.00-1.32]). These associations persisted across various subgroups. CONCLUSIONS: Although malnutrition and inflammation may explain the increased risk for mortality in patients with decreasing serum HDL-C concentrations over time, these indices do not mitigate the elevated risk in patients with rising serum HDL-C. We found that increasing serum HDL-C over time is paradoxically associated with worse outcomes in incident hemodialysis patients. Published by Elsevier Inc.
Authors: Kathrin Untersteller; Sabine Meissl; Markus Trieb; Insa E Emrich; Adam M Zawada; Michael Holzer; Eva Knuplez; Danilo Fliser; Gunnar H Heine; Gunther Marsche Journal: J Lipid Res Date: 2018-05-22 Impact factor: 5.922
Authors: Ki Heon Nam; Tae Ik Chang; Young Su Joo; Joohwan Kim; Sangmi Lee; Changhyun Lee; Hae-Ryong Yun; Jung Tak Park; Tae-Hyun Yoo; Su Ah Sung; Kyu-Beck Lee; Kook-Hwan Oh; Soo Wan Kim; Joongyub Lee; Shin-Wook Kang; Kyu Hun Choi; Curie Ahn; Seung Hyeok Han Journal: J Am Heart Assoc Date: 2019-03-19 Impact factor: 5.501