Higher Cholesterol Level Predicts Cardiovascular Event and Inversely Associates With Mortality in Hemodialysis Patients: 10‐Year Outcomes of the Q‐Cohort Study

Nakano, Toshiaki; Hiyamuta, Hiroto; Yotsueda, Ryusuke; Tanaka, Shigeru; Taniguchi, Masatomo; Tsuruya, Kazuhiko; Kitazono, Takanari

doi:10.1111/1744-9987.13455

Cited by 13 publications

(8 citation statements)

References 26 publications

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“…Furthermore, an observational study that followed hemodialysis patients for 10 years reported that the risk of cardiovascular events increased as cholesterol levels increased. This finding indicates that an intensified cholesterol-lowering treatment may be necessary to reduce the risk of CVD [28]. Of interest, in this study, 3 months of high-dose EPA/DHA reduced RLP-C by approximately 46%, whereas a randomized controlled trial of cilostazol for 6 months in patients with intermittent claudication (n = 56) reduced RLP-C by approximately 20% [29].…”

Section: Discussionmentioning

confidence: 71%

Omega-3 Fatty Acids Reduce Remnant-like Lipoprotein Cholesterol and Improve the Ankle–Brachial Index of Hemodialysis Patients with Dyslipidemia: A Pilot Study

Kobayashi,

Fujikawa,

Haruna

et al. 2023

Medicina

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Background and Objectives: Omega-3 fatty acids have potent lipid-lowering and antiplatelet effects; however, randomized controlled trials have yet to examine the effect of high-dose omega-3 fatty acid administration on peripheral artery disease (PAD) in hemodialysis patients with dyslipidemia. Therefore, this study aimed to evaluate the effects of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) on the ankle–brachial index (ABI) and remnant-like lipoprotein cholesterol (RLP-C) levels, which are indicators of PAD severity. Materials and Methods: Thirty-eight participants (mean age: 73.6 ± 12.7 years) were randomly assigned using stratified block randomization to either conventional therapy alone or conventional therapy supplemented with high-dose EPA/DHA (EPA: 1860 mg; DHA: 1500 mg) for a three-month intervention period. Patients in the conventional therapy alone group who opted to continue were provided with a low-dose EPA/DHA regimen (EPA: 930 mg; DHA: 750 mg) for an additional three months. The baseline and 3-month values for RLP-C, an atherogenic lipid parameter, and the ABI were recorded. Results: The results of the 3-month assessments revealed that the mean RLP-C changes were −3.25 ± 3.15 mg/dL and 0.44 ± 2.53 mg/dL in the EPA/DHA and control groups, respectively (p < 0.001), whereas the changes in the mean ABI values were 0.07 ± 0.11 and −0.02 ± 0.09 in the EPA/DHA and control groups, respectively (p = 0.007). In the EPA/DHA group, a significant negative correlation was found between the changes in RLP-C levels and the ABI (r = −0.475, p = 0.04). Additionally, the change in the RLP-C levels independently influenced the change in the ABI in the EPA/DHA group, even after adjusting for age, sex, and statin use (p = 0.042). Conclusions: Add-on EPA/DHA treatment improved the effectiveness of conventional therapy (such as statin treatment) for improving the ABI in hemodialysis patients with dyslipidemia by lowering RLP-C levels. Therefore, clinicians involved in dialysis should focus on RLP-C when considering residual cardiovascular disease risk in hemodialysis patients and should consider screening patients with elevated levels.

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Section: Discussionmentioning

confidence: 71%

Omega-3 Fatty Acids Reduce Remnant-like Lipoprotein Cholesterol and Improve the Ankle–Brachial Index of Hemodialysis Patients with Dyslipidemia: A Pilot Study

Kobayashi,

Fujikawa,

Haruna

et al. 2023

Medicina

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“…Studies have shown that reducing LDL-C levels did not improve overall survival in either HD patients or the general population 3 16 17. Moreover, lower TC was discovered to be a risk factor for death and was linked to a poor prognosis in maintenance HD patients 18 19. A previous study showed that hypertriglyceridaemia is paradoxically related to better survival 5.…”

Section: Discussionmentioning

confidence: 99%

Association between the triglyceride to high-density lipoprotein cholesterol ratio and mortality in Chinese maintenance haemodialysis patients: a retrospective cohort study

Qi,

Zhang,

Zhang

et al. 2024

BMJ Open

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ObjectiveTo investigate the relationship between the triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) ratio and all-cause and cardiovascular (CV) mortality in Chinese haemodialysis (HD) patients.DesignRetrospective cohort study.SettingPatients from June 2015 to September 2016 and followed through September 2021 were categorised into quartiles according to the follow-up averaged TG/HDL-C ratio. The association between TG/HDL-C and mortality was examined by univariate and multivariate time-varying Cox regression analyses. The C-index was used to assess the predictive accuracy of the Cox regression models.ParticipantsA total of 534 maintenance HD patients were enrolled.Primary and secondary outcome measuresThe outcomes were all-cause death and CV mortality.ResultsDuring the median follow-up of 61 months, 207 patients died, with 94 (45.4%) classified as CV death. After adjusting for confounders, multivariate time-varying Cox regression analysis showed that the quartile 4 group (TG/HDL-C ≥2.64) was associated with decreased all-cause mortality (adjusted HR 0.51, 95% CI 0.33–0.77, p=0.001) and CV mortality (adjusted HR 0.31; 95% CI 0.16 to 0.62; p=0.001) in maintenance HD patients. Model 1 of all-cause mortality achieved a C-index of 0.72 (95% CI 0.68 to 0.75), and model 2 achieved a C-index of 0.77 (95% CI 0.73 to 0.82). The C-index for model 1 in CV mortality was 0.74 (95% CI 0.70 to 0.77), and the C-index for model 2 was 0.80 (95% CI 0.75 to 0.84).ConclusionsHigh TG/HDL-C was associated with decreased all-cause and CV mortality in HD patients.

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“…More than two decades ago, a study of more than 12,000 hemodialysis patients reported that all-cause mortality risk was significantly lower at higher total cholesterol levels [ 6 ]. Since then, many prospective studies in hemodialysis patients have replicated this inverse association [ 15 , 16 ]. A similar inverse association was observed among PD patients.…”

Section: Discussionmentioning

confidence: 99%

Total cholesterol and mortality in peritoneal dialysis: a retrospective cohort study

Yang

Wang

et al. 2023

BMC Nephrol

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Background Total cholesterol is inversely associated with mortality in dialysis patients, which seems implausible in real-world clinical practice. May there be an optimal range of total cholesterol associated with a lower mortality risk? We aimed to evaluate the optimal range for peritoneal dialysis (PD) patients. Methods We conducted a retrospective real-world cohort study of 3565 incident PD patients from five PD centers between January 1, 2005, and May 31, 2020. Baseline variables were collected within one week before the start of PD. The associations between total cholesterol and mortality were examined using cause-specific hazard models. Results 820 (23.0%) patients died, including 415 cardiovascular deaths, during the follow-up period. Restricted spline plots showed a U-curved association of total cholesterol with mortality. Compared with the reference range (4.10–4.50 mmol/L), high levels of total cholesterol (> 4.50 mmol/L) were associated with increased risks of all-cause (hazard ratio [HR] 1.35, 95% confidence index [CI] 1.08–1.67) and cardiovascular mortality (HR 1.38, 95% CI 1.09–1.87). Similarly, compared with the reference range, low levels of total cholesterol (< 4.10mmol/L) were also associated with high risks of all-cause (HR 1.62, 95% CI 1.31–1.95) and cardiovascular mortality (HR 1.72, 95% CI 1.27–2.34). Conclusion Total cholesterol levels at the start of PD between 4.10 and 4.50 mmol/L (158.5 to 174.0 mg/dL), an optimal range, were associated with lower risks of death than higher or lower levels, resulting in a U-shaped association.

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Higher Cholesterol Level Predicts Cardiovascular Event and Inversely Associates With Mortality in Hemodialysis Patients: 10‐Year Outcomes of the Q‐Cohort Study

Cited by 13 publications

References 26 publications

Omega-3 Fatty Acids Reduce Remnant-like Lipoprotein Cholesterol and Improve the Ankle–Brachial Index of Hemodialysis Patients with Dyslipidemia: A Pilot Study

Omega-3 Fatty Acids Reduce Remnant-like Lipoprotein Cholesterol and Improve the Ankle–Brachial Index of Hemodialysis Patients with Dyslipidemia: A Pilot Study

Association between the triglyceride to high-density lipoprotein cholesterol ratio and mortality in Chinese maintenance haemodialysis patients: a retrospective cohort study

Total cholesterol and mortality in peritoneal dialysis: a retrospective cohort study

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