Low-Density Lipoprotein Cholesterol: Association with Mortality and Hospitalization in Hemodialysis Patients

Abstract

Background/Aims: Hypocholesterolemia is a common finding in hospitalized elderly people, critically ill surgical patients, septic patients and end-stage renal disease patients. The different effect of lipid subfractions on patients with end-stage renal disease has never been demonstrated. We aim to study the effect of lipid subfractions on hospitalization and mortality in maintenance hemodialysis (MHD) patients. Methods: Lipid subfractions, including total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C) were measured in 210 patients with MHD in a single dialysis center. Patients were stratified into three groups based on the tertiles of lipid levels, and differences in patient characteristics and survival were evaluated. Results: Of a total of 22 deceased patients in our MHD cohort, infection-related mortality (50%) was higher than cardiovascular-related mortality (18.2%). Significant differences (p < 0.05) in the duration and frequency of hospitalization and in mortality events were observed when patients were divided into different subgroups according to the tertiles of baseline TC and LDL-C levels. Patients with lower LDL had significantly lower levels of albumin, TC and TG. The LDL-C tertiles were similar in terms of age, hypertension, diabetes, biochemical results, hematocrit, adequacy of hemodialysis and normalized protein catabolism rate. Both TC and LDL-C predicted survival (p < 0.001), but not TG and HDL-C in the Kaplan-Meier model. The Cox proportional hazard model demonstrated that baseline serum LDL-C was the best lipid subfraction in predicting all-cause death with an adjusted hazard ratio (95% confidence interval) for each 10 mg/dl of 0.752 (0.631–0.898; p = 0.002). Conclusions: We firstly demonstrated that lipid subfractions, including TC and LDL-C, predict poor outcomes in a MHD cohort with high infection-related mortality.

Association of serum fetuin A with truncal obesity and dyslipidemia in non-diabetic hemodialysis patients

“…In previous investigations, chronic dialysis patients frequently have low HDL-C and LDL-C levels than the general population and predict worse all-cause outcomes (14,15). Although the prevalence of dyslipidemia is extremely high in dialysis patients, the exact relationship of fetuin A and dyslipidemia in these patients is unknown.…”

Effect of intradialytic parenteral nutrition in patients with malnutrition–inflammation complex syndrome on body weight, inflammation, serum lipids and adipocytokines: results from a pilot study

“…Lipid abnormalities are characterized by high TC, a moderate hypertriglyceridemia, high LDL cholesterol and low HDL cholesterol, predicting poor outcomes in patients on chronic HD with high infection-related mortality (Prichard, 2003;Chiang et al, 2005).…”

“…Several studies demonstrated that lipid subfractions, including high total cholesterol (TC), high low-density lipoprotein cholesterol (LDL) and low high-density lipoprotein cholesterol (HDL), predict poor outcome in hemodialysis patients (Prichard, 2003;Chiang et al, 2005).…”

Rosiglitazone in Diabetes Control in Hemodialysis Patients With and Without Viral Hepatitis Infection

“…We prospectively established annual mortality and hospitalization indexes as well as collecting patients' demographic and laboratory data since 2002 as mentioned elsewhere (14,15). Among this population, patients with type 2 diabetes were included if their A1C was Ͼ8% at enrollment, despite management with diet alone or with medications (oral hypoglycemic agents or insulin).…”

“…Plasma adiponectin and interleukin-6 levels were assayed using an enzymelinked immunosorbent assay (R&D Systems, Minneapolis, MN) (5). Serum HBV antigen, anti-hepatitis B surface antibody, and anti-HCV antibody were measured with third-generation enzymelinked immunosorbent assay kits (Abbott, Abbott Park, IL) (14).…”