Hyperlipidemia and long-term outcomes in nondiabetic chronic kidney disease.

Abstract

BACKGROUND AND OBJECTIVES:

Dyslipidemia confers a paradoxical survival advantage in patients with kidney failure. Data are limited in the earlier stages of chronic kidney disease (CKD).

DESIGN, SETTING, PARTICIPANTS, AND MEASUREMENTS:

This was a cohort study in 840 subjects with stage 3 to 4 CKD enrolled in the Modification of Diet in Renal Disease study. Cox models were used to examine the relationship of total cholesterol (TC), non-HDL-cholesterol (NHDL-C), triglycerides (TG), and HDL-cholesterol (HDL-C) with all-cause and cardiovascular disease (CVD) mortality and progression to kidney failure.

RESULTS:

During a mean follow-up of 10 years, there were 208 deaths, 128 deaths from CVD, and 554 subjects reached kidney failure. There was no association between tertiles of any of the lipid variables and mortality; the lowest HDL-C tertile (1.44, 1.18 to 1.78) had increased risk of kidney failure but covariate adjustment abolished this association. In analyses with lipids as continuous variables, there was a significant association with all-cause mortality for TC (hazard ratio [HR] per 10-mg/dl increase, 95% confidence intervals [CI] = 1.03, 1.0 to 1.06) that disappeared with covariate adjustment; there was no association of TG, HDL-C, and NHDL-C as continuous variables with all-cause or CVD mortality. There was a significant inverse association between HDL-C and kidney failure (HR = 0.93, CI = 0.87 to 0.99) in an unadjusted Cox model that was attenuated after adjustment for covariates (HR = 0.98 CI = 0.91 to 1.06).

CONCLUSIONS:

In this cohort, with predominantly nondiabetic CKD patients, hyperlipidemia is not an independent predictor of long-term outcomes.

• Authors: Varun Chawla, Tom Greene, Gerald J Beck, John W Kusek, Allan J Collins, Mark J Sarnak, Vandana Menon
• Journal: Clinical journal of the American Society of Nephrology : CJASN (Clin J Am Soc Nephrol) Vol. 5 Issue 9 Pg. 1582-7 (Sep 2010) ISSN: 1555-905X [Electronic] United States
• PMID: 20558558 (Publication Type: Journal Article, Research Support, N.I.H., Extramural)

Chemical References

• Cholesterol, HDL
• Lipids
• Triglycerides
• Cholesterol

Topics

• Adult
• Chi-Square Distribution
• Cholesterol (blood)
• Cholesterol, HDL (blood)
• Female
• Humans
• Hyperlipidemias (blood, epidemiology, mortality)
• Kidney Diseases (epidemiology, mortality)
• Lipids (blood)
• Male
• Middle Aged
• Prognosis
• Proportional Hazards Models
• Randomized Controlled Trials as Topic
• Risk Assessment
• Risk Factors
• Time Factors
• Triglycerides (blood)
• United States (epidemiology)