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Elevated high-density lipoprotein cholesterol and cardiovascular mortality in maintenance hemodialysis patients.

AbstractBACKGROUND:
High-density lipoprotein (HDL) confers protection against atherosclerosis by several different mechanisms. Although in the general population, increasing levels of HDL are associated with reduced cardiovascular (CV) mortality, this association is not well known in patients with chronic disease states such as end-stage renal disease. We hypothesize that the association of serum HDL concentration and its ratio to total cholesterol with all-cause and CV mortality in hemodialysis patients is different from the general population.
METHODS:
A 3-year (July 2004 to June 2007) cohort of 33 109 chronic hemodialysis patients was studied in the USA in the dialysis clinics where lipid profile was measured in at least 50% of all outpatients of the clinic during a given calendar quarter. Cox proportional hazard models were adjusted for demographics and case-mix variables and cubic splines were plotted.
RESULTS:
Higher HDL concentrations up to 50 mg/dL were associated with better overall survival, while HDL at 60 mg/dL and above was associated with a rise in all-cause and CV mortality. All-cause and CV mortality hazard ratio was 1.28 (1.20-1.38) and 1.08 (1.01-1.16) for HDL <30 mg/dL and 1.05 (1.00-1.10) and 1.08 (1.00-1.16) for HDL ≥ 60 mg/dL, respectively (reference: HDL: 30-<60 mg/dL).
CONCLUSIONS:
In contrast to the general population, low total cholesterol to HDL ratio was associated with higher mortality in hemodialysis patients. A U-shaped association between HDL cholesterol level and all-cause and CV mortality exists in hemodialysis patients with HDL between 50 and <60 mg/dL exhibiting the best survival. The underlying mechanisms responsible for these seemingly paradoxical associations await further investigation.
AuthorsHamid Moradi, Elani Streja, Moti L Kashyap, Nosratola D Vaziri, Gregg C Fonarow, Kamyar Kalantar-Zadeh
JournalNephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association (Nephrol Dial Transplant) Vol. 29 Issue 8 Pg. 1554-62 (Aug 2014) ISSN: 1460-2385 [Electronic] England
PMID24574544 (Publication Type: Journal Article, Multicenter Study, Research Support, N.I.H., Extramural)
Copyright© The Author 2014. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.
Chemical References
  • Biomarkers
  • Cholesterol, HDL
Topics
  • Biomarkers (blood)
  • Cardiovascular Diseases (blood, etiology, mortality)
  • Cause of Death (trends)
  • Cholesterol, HDL (blood)
  • Female
  • Follow-Up Studies
  • Humans
  • Incidence
  • Kidney Failure, Chronic (blood, complications, therapy)
  • Male
  • Middle Aged
  • Prognosis
  • Proportional Hazards Models
  • Renal Dialysis
  • Retrospective Studies
  • Survival Rate (trends)
  • Time Factors
  • United States (epidemiology)

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