Association of Cholesterol Levels with Mortality and Cardiovascular Events among Patients with CKD and Different Amounts of Proteinuria

Chen, Szu-Chia; Hung, Chi‐Chih; Tsai, Yi‐Chun; Huang, Jiun-Chi; Kuo, Mei‐Chuan; Lee, Jia-Jung; Chiu, Yi‐Wen; Chang, Jer‐Ming; Hwang, Shiuh-Lin; Chen, Hung‐Chun

doi:10.2215/cjn.02350213

Cited by 8 publications

(5 citation statements)

References 27 publications

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“…Previous studies have shown that TC level was associated with a higher risk of mortality in patients with chronic renal failure [ 20 21 ]. Chen et al [ 22 ] in a more recent large-scale study among 3,303 patients with chronic kidney disease stages 3 to 5, observed that the association between TC and mortality is different among patients with different levels of proteinuria. Though Pearson correlation analysis did not demonstrate any significant correlation between HDL-C and eGFR, HDL-C was identified to be associated with declining eGFR in our study, on regression analysis.…”

Section: Discussionmentioning

confidence: 99%

Lipid Abnormalities in Type 2 Diabetes Mellitus Patients with Overt Nephropathy

Palazhy

Viswanathan

2017

Diabetes Metab J

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BackgroundDiabetic nephropathy is a major complication of diabetes and an established risk factor for cardiovascular events. Lipid abnormalities occur in patients with diabetic nephropathy, which further increase their risk for cardiovascular events. We compared the degree of dyslipidemia among type 2 diabetes mellitus (T2DM) subjects with and without nephropathy and analyzed the factors associated with nephropathy among them.MethodsIn this retrospective study, T2DM patients with overt nephropathy were enrolled in the study group (n=89) and without nephropathy were enrolled in the control group (n=92). Both groups were matched for age and duration of diabetes. Data on total cholesterol (TC), triglycerides (TG), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), urea and creatinine were collected from the case sheets. TG/HDL-C ratio, a surrogate marker for small, dense, LDL particles (sdLDL) and estimated glomerular filtration rate (eGFR) were calculated using equations. Multivariate analysis was done to determine the factors associated with eGFR.ResultsDyslipidemia was present among 56.52% of control subjects and 75.28% of nephropathy subjects (P=0.012). The percentage of subjects with atherogenic dyslipidemia (high TG+low HDL-C+sdLDL) was 14.13 among controls and 14.61 among nephropathy subjects. Though serum creatinine was not significantly different, mean eGFR value was significantly lower among nephropathy patients (P=0.002). Upon multivariate analysis, it was found that TC (P=0.007) and HDL-C (P=0.06) were associated with eGFR among our study subjects.ConclusionOur results show that dyslipidemia was highly prevalent among subjects with nephropathy. Regular screening for dyslipidemia may be beneficial in controlling the risk for adverse events among diabetic nephropathy patients.

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Section: Discussionmentioning

confidence: 99%

Lipid Abnormalities in Type 2 Diabetes Mellitus Patients with Overt Nephropathy

Palazhy

Viswanathan

2017

Diabetes Metab J

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“…Baseline proteinuria is known to be associated with the risk of CKD progression in both nondiabetic [ 28 ] and diabetic [ 29 , 30 ] patients. Recently Chen et al also reported that various degrees of proteinuria may have different impact on cardiovascular events and all-cause mortality [ 31 ]. However, the interrelationship between proteinuria and vascular calcification remains unclear.…”

Section: Discussionmentioning

confidence: 99%

Aortic Arch Calcification Predicts the Renal Function Progression in Patients with Stage 3 to 5 Chronic Kidney Disease

Lee

et al. 2015

BioMed Research International

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Introduction. The presence of aortic arch calcification (AoAC) and cardiomegaly on chest radiography has been demonstrated as important risk factors for cardiovascular mortality in patients with chronic kidney disease (CKD). However, the interrelationship among AoAC, cardiomegaly, and renal function progression remains unclear. The aim of this study is to assess whether AoAC and cardiomegaly are independently associated with the renal function progression in patients with stages 3–5 CKD. Methods. We retrospectively determined AoAC and cardiomegaly by chest X-ray in 237 patients, followed up for at least three years without entering dialysis and classified into 4 groups according to the presence or absence of AoAC and cardiomegaly. The change in renal function was measured by the slope of estimated glomerular filtration rate (eGFR). Results. Of the 237 patients, the rate of eGFR decline was significantly higher in the group with coexistence of AoAC and cardiomegaly than any other groups. Baseline AoAC and proteinuria were independently associated with eGFR decline. AoAC were independently determined by age, eGFR slope, and cardiomegaly. Conclusions. The coexistence of AoAC and cardiomegaly is associated with faster eGFR decline. AoAC is an independent determinant of renal outcomes in patients with CKD stages 3–5.

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“…All clinically relevant covariates were selected according to our previous publications and literature and continuous variables with a skewed distribution were log transformed to attain normal distribution. Adjusted covariates included age, gender, hypertension, CVD, diabetes mellitus, current smoking status, MAP, eGFR, log-transformed Upcr, albumin, hemoglobin, HbA1C, log-transformed total cholesterol, log-transformed CRP, and phosphorus [ 23 – 25 ]. Cox survival analyses with pre-specified subgroups were also performed by adding appropriate cross-product interaction terms including age, gender, CVD, CKD stages, Upcr, hemoglobin, albumin, and CRP.…”

Section: Methodsmentioning

confidence: 99%

Body Mass Index, Mortality, and Gender Difference in Advanced Chronic Kidney Disease

Huang

Lin²,

Lim³

et al. 2015

PLoS ONE

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Background and AimA higher body mass index (BMI) appears to be reversely associated with mortality in dialysis patients. Moreover, although women have better survival in chronic kidney disease (CKD), this survival advantage is cancelled in dialysis. The association between BMI and mortality and the gender difference remain controversial in advanced CKD.MethodsThis study enrolled 3,320 patients (1,938 men and 1,382 women) from southern Taiwan who had CKD stages 3–5 with a BMI of 15.0–35.0 kg/m2.ResultsDuring a median 2.9-year follow-up, there were 328 (16.9%) all-cause mortality and 319 (16.5%) cardiovascular (CV) events and death in male patients, 213 (15.4%) all-cause mortality and 224 (16.2%) CV events and death in female patients. Compared with the reference BMI of 27.6–30.0 kg/m2 in an adjusted Cox model, lower-BMI groups in men, BMI 15.0–20.0 kg/m2 and 20.1–22.5 kg/m2, were associated with higher risks of all-cause mortality: hazard ratios (HRs) 3.19 (95% confidence interval [CI], 1.97–5.18) and 2.01 (95% CI, 1.29–3.14), respectively. Higher-BMI group in men, BMI 30.1–35.0 kg/m2, was associated with a higher risk of all-cause mortality: HR 1.72 (95% CI, 1.02–2.96). Likewise, lower- and higher-BMI groups in men were associated with a higher risk of CV events and death. In women, these associations between BMI and poor outcomes were not observed.ConclusionsIn advanced CKD, there was a reverse J-shaped association between BMI and all-cause mortality, and a U-shaped association between BMI and CV outcomes in men. Neutral associations between BMI and poor outcomes were detected in women. Gender could modify the effect of BMI on mortality in patients with CKD.

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Association of Cholesterol Levels with Mortality and Cardiovascular Events among Patients with CKD and Different Amounts of Proteinuria

Cited by 8 publications

References 27 publications

Lipid Abnormalities in Type 2 Diabetes Mellitus Patients with Overt Nephropathy

Lipid Abnormalities in Type 2 Diabetes Mellitus Patients with Overt Nephropathy

Aortic Arch Calcification Predicts the Renal Function Progression in Patients with Stage 3 to 5 Chronic Kidney Disease

Body Mass Index, Mortality, and Gender Difference in Advanced Chronic Kidney Disease

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