Low-Density Lipoprotein Cholesterol and Mortality in Peritoneal Dialysis
BackgroundIn dialysis patients, lowering low-density lipoprotein cholesterol (LDL-C) did not provide benefits, which seemed implausible in clinical practice. We hypothesized a U-shaped association between LDL-C and mortality in dialysis patients.MethodsIn this multi-center retrospective real-world c...
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| Format: | Article |
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Frontiers Media S.A.
2022-07-01
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| Series: | Frontiers in Nutrition |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fnut.2022.910348/full |
| _version_ | 1818047795867680768 |
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| author | Xianfeng Wu Xianfeng Wu Lei Zhou Xiaojiang Zhan Yueqiang Wen Xiaoyang Wang Xiaoran Feng Niansong Wang Niansong Wang Fenfen Peng Junnan Wu |
| author_facet | Xianfeng Wu Xianfeng Wu Lei Zhou Xiaojiang Zhan Yueqiang Wen Xiaoyang Wang Xiaoran Feng Niansong Wang Niansong Wang Fenfen Peng Junnan Wu |
| author_sort | Xianfeng Wu |
| collection | DOAJ |
| description | BackgroundIn dialysis patients, lowering low-density lipoprotein cholesterol (LDL-C) did not provide benefits, which seemed implausible in clinical practice. We hypothesized a U-shaped association between LDL-C and mortality in dialysis patients.MethodsIn this multi-center retrospective real-world cohort study, 3,565 incident Chinese peritoneal dialysis (PD) patients between January 1, 2005, and May 31, 2020, were included. The associations between baseline LDL-C and mortality were examined using cause-specific hazard models.ResultsOf 3,565 patients, 820 died, including 415 cardiovascular deaths. As compared with the reference range (2.26-2.60 mmol/L), both higher levels of LDL-C (> 2.60 mmol/L) and lower levels of LDL-C (< 2.26 mmol/L) were associated with increased risks of all-cause mortality (hazard ratio [HR],1.35, 95% confidence index [CI], 1.09-1.66; HR 1.36, 95%CI, 1.13-1.64) and cardiovascular mortality (HR, 1.31, 95% CI, 1.10-1.72; HR, 1.64; 95% CI, 1.22-2.19). Malnutrition (albumin < 36.0 g/L) modified the association between LDL-C and cardiovascular mortality (P for interaction = 0.01). A significantly increased risk of cardiovascular mortality was observed among patients with malnutrition and lower levels of LDL-C (HR 2.96, 95%CI 1.43-6.12) or higher levels of LDL-C (HR 2.81, 95%CI 1.38-5.72).ConclusionLow and high levels of LDL-C at the start of PD procedure were associated with increased all-cause and cardiovascular mortality risks. Malnutrition may modify the association of LDL-C with cardiovascular mortality. |
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| format | Article |
| id | doaj.art-8775deb686064227a63ffcf200ebc126 |
| institution | Directory Open Access Journal |
| issn | 2296-861X |
| language | English |
| last_indexed | 2024-12-10T10:11:28Z |
| publishDate | 2022-07-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Nutrition |
| spelling | doaj.art-8775deb686064227a63ffcf200ebc1262022-12-22T01:53:06ZengFrontiers Media S.A.Frontiers in Nutrition2296-861X2022-07-01910.3389/fnut.2022.910348910348Low-Density Lipoprotein Cholesterol and Mortality in Peritoneal DialysisXianfeng Wu0Xianfeng Wu1Lei Zhou2Xiaojiang Zhan3Yueqiang Wen4Xiaoyang Wang5Xiaoran Feng6Niansong Wang7Niansong Wang8Fenfen Peng9Junnan Wu10Department of Nephrology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, ChinaClinical Research Center for Chronic Kidney Disease, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, ChinaEvergreen Tree Nephrology Association, Guangzhou, ChinaDepartment of Nephrology, The First Affiliated Hospital of Nanchang University, Nanchang, ChinaDepartment of Nephrology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, ChinaDepartment of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, ChinaDepartment of Nephrology, Jiujiang No. 1 People’s Hospital, Jiujiang, ChinaDepartment of Nephrology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, ChinaClinical Research Center for Chronic Kidney Disease, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, ChinaDepartment of Nephrology, Zhujiang Hospital of Southern Medical University, Guangzhou, ChinaDepartment of Nephrology, Zhejiang University Medical College Affiliated Sir Run Run Shaw Hospital, Hangzhou, ChinaBackgroundIn dialysis patients, lowering low-density lipoprotein cholesterol (LDL-C) did not provide benefits, which seemed implausible in clinical practice. We hypothesized a U-shaped association between LDL-C and mortality in dialysis patients.MethodsIn this multi-center retrospective real-world cohort study, 3,565 incident Chinese peritoneal dialysis (PD) patients between January 1, 2005, and May 31, 2020, were included. The associations between baseline LDL-C and mortality were examined using cause-specific hazard models.ResultsOf 3,565 patients, 820 died, including 415 cardiovascular deaths. As compared with the reference range (2.26-2.60 mmol/L), both higher levels of LDL-C (> 2.60 mmol/L) and lower levels of LDL-C (< 2.26 mmol/L) were associated with increased risks of all-cause mortality (hazard ratio [HR],1.35, 95% confidence index [CI], 1.09-1.66; HR 1.36, 95%CI, 1.13-1.64) and cardiovascular mortality (HR, 1.31, 95% CI, 1.10-1.72; HR, 1.64; 95% CI, 1.22-2.19). Malnutrition (albumin < 36.0 g/L) modified the association between LDL-C and cardiovascular mortality (P for interaction = 0.01). A significantly increased risk of cardiovascular mortality was observed among patients with malnutrition and lower levels of LDL-C (HR 2.96, 95%CI 1.43-6.12) or higher levels of LDL-C (HR 2.81, 95%CI 1.38-5.72).ConclusionLow and high levels of LDL-C at the start of PD procedure were associated with increased all-cause and cardiovascular mortality risks. Malnutrition may modify the association of LDL-C with cardiovascular mortality.https://www.frontiersin.org/articles/10.3389/fnut.2022.910348/fullperitoneal dialysismortalitylow-density lipoprotein cholesterol (LDL-C)nutrition–clinicalcardiovascular mortality |
| spellingShingle | Xianfeng Wu Xianfeng Wu Lei Zhou Xiaojiang Zhan Yueqiang Wen Xiaoyang Wang Xiaoran Feng Niansong Wang Niansong Wang Fenfen Peng Junnan Wu Low-Density Lipoprotein Cholesterol and Mortality in Peritoneal Dialysis Frontiers in Nutrition peritoneal dialysis mortality low-density lipoprotein cholesterol (LDL-C) nutrition–clinical cardiovascular mortality |
| title | Low-Density Lipoprotein Cholesterol and Mortality in Peritoneal Dialysis |
| title_full | Low-Density Lipoprotein Cholesterol and Mortality in Peritoneal Dialysis |
| title_fullStr | Low-Density Lipoprotein Cholesterol and Mortality in Peritoneal Dialysis |
| title_full_unstemmed | Low-Density Lipoprotein Cholesterol and Mortality in Peritoneal Dialysis |
| title_short | Low-Density Lipoprotein Cholesterol and Mortality in Peritoneal Dialysis |
| title_sort | low density lipoprotein cholesterol and mortality in peritoneal dialysis |
| topic | peritoneal dialysis mortality low-density lipoprotein cholesterol (LDL-C) nutrition–clinical cardiovascular mortality |
| url | https://www.frontiersin.org/articles/10.3389/fnut.2022.910348/full |
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