The Clinical Significance of LDL-Cholesterol on the Outcomes of Hemodialysis Patients with Acute Coronary Syndrome
<i>Background and objectives</i>: Dyslipidemia is one of the most important modifiable risk factors in the pathogenesis of cardiovascular disease in the general population, but its importance in the hemodialysis (HD) population is uncertain. <i>Materials and Methods</i>: This...
| Main Authors: | , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2023-07-01
|
| Series: | Medicina |
| Subjects: | |
| Online Access: | https://www.mdpi.com/1648-9144/59/7/1312 |
| _version_ | 1797588330028728320 |
|---|---|
| author | Keren Cohen-Hagai Sydney Benchetrit Ori Wand Ayelet Grupper Moshe Shashar Olga Solo David Pereg Tali Zitman-Gal Feras Haskiah Daniel Erez |
| author_facet | Keren Cohen-Hagai Sydney Benchetrit Ori Wand Ayelet Grupper Moshe Shashar Olga Solo David Pereg Tali Zitman-Gal Feras Haskiah Daniel Erez |
| author_sort | Keren Cohen-Hagai |
| collection | DOAJ |
| description | <i>Background and objectives</i>: Dyslipidemia is one of the most important modifiable risk factors in the pathogenesis of cardiovascular disease in the general population, but its importance in the hemodialysis (HD) population is uncertain. <i>Materials and Methods</i>: This retrospective cohort study includes HD patients hospitalized due to acute coronary syndrome (ACS) in the period 2015–2020 with lipid profile data during ACS. A control group with preserved kidney function was matched. Risk factors for 30-day and 1-year mortality were assessed. <i>Results</i>: Among 349 patients included in the analysis, 246 were HD-dependent (“HD group”). HD group patients had higher prevalence of diabetes, hypertension, and heart disease than the control group. At ACS hospitalization, lipid profile and chronic statin treatment were comparable between groups. Odds ratios for 30-day mortality in HD vs. control group was 5.2 (95% CI 1.8–15; <i>p</i> = 0.002) and for 1-year, 3.4 (95% CI 1.9–6.1; <i>p</i> <0.001). LDL and LDL < 70 did not change 30-day and 1-year mortality rates in the HD group (<i>p</i> = 0.995, 0.823, respectively). However, survival after ACS in HD patients correlated positively with nutritional parameters such as serum albumin (r = 0.368, <i>p</i> < 0.001) and total cholesterol (r = 0.185, <i>p</i> < 0.001), and inversely with the inflammatory markers C-reactive protein (CRP; r = −0.348, <i>p</i> < 0.001) and neutrophils-to-lymphocytes ratio (NLR; r = −0.181, <i>p</i> = 0.019). Multivariate analysis demonstrated that heart failure was the only significant predictor of 1-year mortality (OR 2.8, <i>p</i> = 0.002). LDL < 70 mg/dL at ACS hospitalization did not predict 1-year mortality in the HD group. <i>Conclusions</i>: Despite comparable lipid profiles and statin treatment before and after ACS hospitalization, mortality rates were significantly higher among HD group. While malnutrition–inflammation markers were associated with survival of dialysis patients after ACS, LDL cholesterol was not. Thus, our study results emphasize that better nutritional status and less inflammation are associated with improved survival among HD patients. |
| first_indexed | 2024-03-11T00:50:27Z |
| format | Article |
| id | doaj.art-07e73ab5756c415c9c3d25147f96a29a |
| institution | Directory Open Access Journal |
| issn | 1010-660X 1648-9144 |
| language | English |
| last_indexed | 2024-03-11T00:50:27Z |
| publishDate | 2023-07-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Medicina |
| spelling | doaj.art-07e73ab5756c415c9c3d25147f96a29a2023-11-18T20:24:58ZengMDPI AGMedicina1010-660X1648-91442023-07-01597131210.3390/medicina59071312The Clinical Significance of LDL-Cholesterol on the Outcomes of Hemodialysis Patients with Acute Coronary SyndromeKeren Cohen-Hagai0Sydney Benchetrit1Ori Wand2Ayelet Grupper3Moshe Shashar4Olga Solo5David Pereg6Tali Zitman-Gal7Feras Haskiah8Daniel Erez9Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba 44281, IsraelDepartment of Nephrology and Hypertension, Meir Medical Center, Kfar Saba 44281, IsraelDivision of Pulmonary Medicine, Barzilai University Medical Center, Ashkelon 7830604, IsraelFaculty of Medicine, Tel Aviv University, Tel Aviv 69978, IsraelDepartment of Nephrology and Hypertension, Laniado Hospital, Netanya 4244916, IsraelDepartment of Anesthesiology, Pain and Intensive Care, Meir Medical Center, Kfar Saba 4428164, IsraelDepartment of Cardiology, Meir Medical Center, Kfar Saba 4428164, IsraelDepartment of Nephrology and Hypertension, Meir Medical Center, Kfar Saba 44281, IsraelFaculty of Medicine, Tel Aviv University, Tel Aviv 69978, IsraelFaculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel<i>Background and objectives</i>: Dyslipidemia is one of the most important modifiable risk factors in the pathogenesis of cardiovascular disease in the general population, but its importance in the hemodialysis (HD) population is uncertain. <i>Materials and Methods</i>: This retrospective cohort study includes HD patients hospitalized due to acute coronary syndrome (ACS) in the period 2015–2020 with lipid profile data during ACS. A control group with preserved kidney function was matched. Risk factors for 30-day and 1-year mortality were assessed. <i>Results</i>: Among 349 patients included in the analysis, 246 were HD-dependent (“HD group”). HD group patients had higher prevalence of diabetes, hypertension, and heart disease than the control group. At ACS hospitalization, lipid profile and chronic statin treatment were comparable between groups. Odds ratios for 30-day mortality in HD vs. control group was 5.2 (95% CI 1.8–15; <i>p</i> = 0.002) and for 1-year, 3.4 (95% CI 1.9–6.1; <i>p</i> <0.001). LDL and LDL < 70 did not change 30-day and 1-year mortality rates in the HD group (<i>p</i> = 0.995, 0.823, respectively). However, survival after ACS in HD patients correlated positively with nutritional parameters such as serum albumin (r = 0.368, <i>p</i> < 0.001) and total cholesterol (r = 0.185, <i>p</i> < 0.001), and inversely with the inflammatory markers C-reactive protein (CRP; r = −0.348, <i>p</i> < 0.001) and neutrophils-to-lymphocytes ratio (NLR; r = −0.181, <i>p</i> = 0.019). Multivariate analysis demonstrated that heart failure was the only significant predictor of 1-year mortality (OR 2.8, <i>p</i> = 0.002). LDL < 70 mg/dL at ACS hospitalization did not predict 1-year mortality in the HD group. <i>Conclusions</i>: Despite comparable lipid profiles and statin treatment before and after ACS hospitalization, mortality rates were significantly higher among HD group. While malnutrition–inflammation markers were associated with survival of dialysis patients after ACS, LDL cholesterol was not. Thus, our study results emphasize that better nutritional status and less inflammation are associated with improved survival among HD patients.https://www.mdpi.com/1648-9144/59/7/1312cardiovascular diseasedyslipidemiaLDL cholesterolhemodialysischronic kidney disease |
| spellingShingle | Keren Cohen-Hagai Sydney Benchetrit Ori Wand Ayelet Grupper Moshe Shashar Olga Solo David Pereg Tali Zitman-Gal Feras Haskiah Daniel Erez The Clinical Significance of LDL-Cholesterol on the Outcomes of Hemodialysis Patients with Acute Coronary Syndrome Medicina cardiovascular disease dyslipidemia LDL cholesterol hemodialysis chronic kidney disease |
| title | The Clinical Significance of LDL-Cholesterol on the Outcomes of Hemodialysis Patients with Acute Coronary Syndrome |
| title_full | The Clinical Significance of LDL-Cholesterol on the Outcomes of Hemodialysis Patients with Acute Coronary Syndrome |
| title_fullStr | The Clinical Significance of LDL-Cholesterol on the Outcomes of Hemodialysis Patients with Acute Coronary Syndrome |
| title_full_unstemmed | The Clinical Significance of LDL-Cholesterol on the Outcomes of Hemodialysis Patients with Acute Coronary Syndrome |
| title_short | The Clinical Significance of LDL-Cholesterol on the Outcomes of Hemodialysis Patients with Acute Coronary Syndrome |
| title_sort | clinical significance of ldl cholesterol on the outcomes of hemodialysis patients with acute coronary syndrome |
| topic | cardiovascular disease dyslipidemia LDL cholesterol hemodialysis chronic kidney disease |
| url | https://www.mdpi.com/1648-9144/59/7/1312 |
| work_keys_str_mv | AT kerencohenhagai theclinicalsignificanceofldlcholesterolontheoutcomesofhemodialysispatientswithacutecoronarysyndrome AT sydneybenchetrit theclinicalsignificanceofldlcholesterolontheoutcomesofhemodialysispatientswithacutecoronarysyndrome AT oriwand theclinicalsignificanceofldlcholesterolontheoutcomesofhemodialysispatientswithacutecoronarysyndrome AT ayeletgrupper theclinicalsignificanceofldlcholesterolontheoutcomesofhemodialysispatientswithacutecoronarysyndrome AT mosheshashar theclinicalsignificanceofldlcholesterolontheoutcomesofhemodialysispatientswithacutecoronarysyndrome AT olgasolo theclinicalsignificanceofldlcholesterolontheoutcomesofhemodialysispatientswithacutecoronarysyndrome AT davidpereg theclinicalsignificanceofldlcholesterolontheoutcomesofhemodialysispatientswithacutecoronarysyndrome AT talizitmangal theclinicalsignificanceofldlcholesterolontheoutcomesofhemodialysispatientswithacutecoronarysyndrome AT ferashaskiah theclinicalsignificanceofldlcholesterolontheoutcomesofhemodialysispatientswithacutecoronarysyndrome AT danielerez theclinicalsignificanceofldlcholesterolontheoutcomesofhemodialysispatientswithacutecoronarysyndrome AT kerencohenhagai clinicalsignificanceofldlcholesterolontheoutcomesofhemodialysispatientswithacutecoronarysyndrome AT sydneybenchetrit clinicalsignificanceofldlcholesterolontheoutcomesofhemodialysispatientswithacutecoronarysyndrome AT oriwand clinicalsignificanceofldlcholesterolontheoutcomesofhemodialysispatientswithacutecoronarysyndrome AT ayeletgrupper clinicalsignificanceofldlcholesterolontheoutcomesofhemodialysispatientswithacutecoronarysyndrome AT mosheshashar clinicalsignificanceofldlcholesterolontheoutcomesofhemodialysispatientswithacutecoronarysyndrome AT olgasolo clinicalsignificanceofldlcholesterolontheoutcomesofhemodialysispatientswithacutecoronarysyndrome AT davidpereg clinicalsignificanceofldlcholesterolontheoutcomesofhemodialysispatientswithacutecoronarysyndrome AT talizitmangal clinicalsignificanceofldlcholesterolontheoutcomesofhemodialysispatientswithacutecoronarysyndrome AT ferashaskiah clinicalsignificanceofldlcholesterolontheoutcomesofhemodialysispatientswithacutecoronarysyndrome AT danielerez clinicalsignificanceofldlcholesterolontheoutcomesofhemodialysispatientswithacutecoronarysyndrome |