期刊
JOURNAL OF INTERNAL MEDICINE
卷 290, 期 4, 页码 910-921出版社
WILEY
DOI: 10.1111/joim.13291
关键词
albumin; cholesterol; chronic kidney disease; haemodialysis; inflammation; lipid profile; mortality
资金
- Amgen (Europe) GmbH, Rotkreuz, Switzerland
- Strategic Research Program in Diabetes at Karolinska Institutet (Swedish Research Council) [2009-1068]
- Heart and Lung Foundation [20160384]
- Njurfonden
- Westmans Foundation
- Novo Nordisk
- Karolinska Institutet, Stockholm, Sweden
- Karolinska Institutet Research Foundation
- Swedish Kidney Foundation (Njurfonden)
- EFSD Mentorship Programme by AstraZeneca
- German Research Foundation [SFB TRR 219]
- National Institute for Health Research (UK) Clinician Scientist Award
In patients with end-stage kidney disease, there is an inverse relationship between lipid profile and mortality in European haemodialysis patients, which is not affected by inflammation/malnutrition.
Background Patients with end-stage kidney disease have an extremely high cardiovascular mortality rate, but there is a paradoxical relationship between lipid profile and survival in haemodialysis patients. To investigate whether inflammation/malnutrition confounds the associations between lipids and mortality, we studied a full lipid profile comprising of five clinically well-established lipid parameters and its associations with mortality in a large, multinational European cohort with a median follow-up >3 years. Methods The association between quartiles of total, high-density lipoprotein (HDL), non-HDL, low-density lipoprotein (LDL) cholesterol, as well as triglyceride, levels and the end-points of all-cause, cardiovascular and non-cardiovascular mortality was assessed in a cohort of 5,382 incident, adult haemodialysis patients from >250 Fresenius Medical Care dialysis centres out of 14 participating countries using baseline and time-dependent Cox models. Analyses were fully adjusted and stratified for inflammation/malnutrition status and other patient-level variables. Results Time-dependent quartiles of total, HDL, non-HDL and LDL cholesterol were inversely associated with the hazard for all-cause, cardiovascular and non-cardiovascular mortality. Compared with the lowest quartile of the respective lipid parameter, hazard ratios of other quartiles were <0.86. Similar, albeit weaker, associations were found with baseline lipid profile and mortality. Neither time-dependent nor baseline associations between lipid profile and mortality were affected by inflammation/malnutrition, statin use or geography. Conclusions Baseline and time-dependent lipid profile are inversely associated with mortality in a large, multicentre cohort of incident haemodialysis patients. Inflammation/malnutrition is not a confounder nor effect modificator of the associations between lipid profile and mortality in European haemodialysis patients.
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