There is a U shaped association between non high density lipoprotein cholesterol with overall and cardiovascular mortality in chronic kidney disease stage 3–5

Abstract

Hsuan chiu 1 , pei-Yu Wu 2,3,4 , Jiun-chi Huang 2,3,4 , Hung-pin tu 5 , Ming-Yen Lin 2 , Szu-chia chen 2,3,4,6* & Jer-Ming chang 2,4 Dyslipidemia is common in patients with chronic kidney disease (cKD), however the relationship between dyslipidemia and mortality in patients with moderate to severe cKD remains controversial. non-high-density lipoprotein (HDL) cholesterol has been reported to be a more accurate predictor of clinical outcomes than conventional lipid measurements. Hence, the aim of this study was to investigate associations between non-HDL cholesterol and the risk of overall and cardiovascular mortality in patients with CKD stage 3-5. We enrolled 429 pre-dialysis patients with stage 3 to 5 CKD from May 2006 to January 2010. The patients were divided into four groups according to quartiles of non-HDL cholesterol. The patients were followed until death or until January 2020. During a median 11.6 years of follow-up, there were 78 (18.2%) deaths overall and 32 (7.5%) cardiovascular deaths. In adjusted models, the patients in quartile 1 (hazard ratio [HR] 3.368; 95% confidence interval [CI] 1.388-8.176; p = 0.007), quartile 3 (HR 3.666; 95% CI 1.486-9.044; p = 0.005), and quartile 4 (HR 2.868; 95% CI 1.136-7.240; p = 0.026) of non-HDL cholesterol had a higher risk of overall mortality (vs. quartile 2). In addition, the patients in quartile 1 (HR 19.503; 95% CI 2.185-174.0925 p = 0.008), quartile 3 (HR 28.702; 95% CI 2.990-275.559; p = 0.004), and quartile 4 (HR 11.136; 95% CI 1.126-110.108; p = 0.039) had a higher risk of cardiovascular mortality (vs. quartile 2). Our study showed a U-shaped relationship between non-HDL cholesterol and the risk of overall and cardiovascular mortality in patients with CKD stage 3-5. Assessing non-HDL cholesterol may help to identify subjects at high-risk of adverse outcomes. Lipid disorders are a major public health issue worldwide, and many studies have reported the high rates of mortality, morbidity, and complications associated with dyslipidemia in the general population 1,2. Dyslipidemia is common in patients with chronic kidney disease (CKD) due to severe dysregulation of key metabolic pathways and enzymes, which can lead to a decrease in high-density lipoprotein (HDL) cholesterol and increase in triglyceride-rich lipoproteins 3. Lipid disorders in patients with CKD have been shown to both increase the risk of cardiovascular disease (CVD) and also to accelerate the progression to end-stage CKD 4-6. High levels of serum low-density lipoprotein (LDL) cholesterol have been clearly identified to be an important risk factor for increased CVD and mortality in the general population, however this cannot completely explain

The U-Shaped Association of Non-High-Density Lipoprotein Cholesterol Levels With All-Cause and Cardiovascular Mortality Among Patients With Hypertension

“…We also observed that lower non-HDL-C linked to higher mortality risk in hypertensive population. Consistent with our results, Chiu et al also found the U-shaped association in chronic kidney disease patients; the lowest mortality risk was observed at non-HDL-C levels of 116.2–143.9 mg/dl, and non-HDL-C <116.2 mg/dl appeared with higher mortality ( 27 ). Non-HDL-C was inversely associated with mortality among hemodialysis patients in the analysis of Chang et al ( 24 ).…”

“…Similar inverse associations were also found in elderly ( 25 , 26 ). Recently, a U-shaped relationship was also discovered ( 27 ). In hypertensive population, rising non-HDL-C could develop arterial stiffness ( 28 , 29 ) and even accelerate the process of hypertension ( 30 ).…”

Impacts of Heart Failure and Physical Performance on Long-Term Mortality in Old Patients With Chronic Kidney Disease

“…Among patients with CKD, however, this relationship is much less obvious. Low total and LDL-C levels were also associated with higher mortality in patients with moderate to advanced stages of CKD, who were not yet on dialysis (33). The inverse association between low total and LDL-C levels and mortality may be explained in part by the presence of the so-called malnutrition-inflammation syndrome (32).…”

CHA₂DS₂-VASc Score as a Predictor of Cardiovascular and All-Cause Mortality in Chronic Kidney Disease Patients

“…Lower total and LDL cholesterol are markers of protein-energy wasting in CKD patients and were shown to be associated with increased death risk in hemodialysis patients, but the results in CKD patients were conflicting [17]. In a newer study by Chiu et al [18], a U-shaped relationship between non-high-density lipoprotein cholesterol and the risk of overall and cardiovascular mortality in patients with CKD stage 3–5 was established. Interestingly, we found no significant difference in hemoglobin between the groups; however, in multivariate Cox regression analysis, hemoglobin reached borderline significance for cardiovascular mortality, and it was a significant predictor of all-cause mortality.…”