Habib Arsalan N, Baird Bradley C, Leypoldt John K, Cheung Alfred K, Goldfarb-Rumyantzev Alexander S
Dialysis Program, University of Utah School of Medicine, 30 North Medical Drive, Salt Lake City, UT 84132, USA.
Nephrol Dial Transplant. 2006 Oct;21(10):2881-92. doi: 10.1093/ndt/gfl272. Epub 2006 May 30.
The role of traditional risk factors, including plasma lipids, in the pathogenesis of cardiovascular (CV) disease in chronic dialysis patients is unclear. Previous studies have suggested that lower serum total cholesterol (TC) is associated with higher mortality in patients on chronic haemodialysis (HD). Whether this relationship is specific to the HD population or is common to the uraemic state is unclear. The present study evaluated the association of serum TC and triglycerides with clinical outcomes in chronic peritoneal dialysis (PD) patients.
Data of 1053 PD patients from the United States Renal Data System (USRDS) prospective Dialysis Morbidity and Mortality Study Wave 2 were examined. Cox regression was used to evaluate the relationship between lipid levels and mortality.
Patients with TC levels < or =125 mg/dl (3.24 mmol/l) had a statistically significant increased risk of an all-cause mortality, including those taking or not taking lipid-modifying medications, compared with the reference of 176-225 mg/dl (4.54-5.83 mmol/l). In stratified analysis, this association was demonstrated in patients with serum albumin >3.0 g/dl (30 g/l), but not with albumin < or =3.0 g/dl. Compared with patients with triglyceride levels of 201-300 mg/dl (2.27-3.39 mmol/l), a statistically significant reduction of all-cause, but not CV, mortality was observed in patients with triglyceride levels of 101-200 mg/dl (1.14-2.26 mmol/l), as well as in the subgroup with serum albumin levels <3.0 g/dl (30 g/l) and triglycerides of < or =100 mg/dl (1.13 mmol/l) and 101-200 mg/dl (1.14-2.26 mmol/l).
While confounding factors and causal pathways have not been clearly identified, aggressive lowering of plasma cholesterol in PD patients is not supported by this study, however, treatment of hypertriglyceridaemia may be warranted with triglyceride levels >200 mg/dl (2.26 mmol/l).
包括血脂在内的传统危险因素在慢性透析患者心血管疾病发病机制中的作用尚不清楚。既往研究表明，慢性血液透析（HD）患者血清总胆固醇（TC）降低与较高的死亡率相关。这种关系是HD人群特有的，还是尿毒症状态共有的，目前尚不清楚。本研究评估了慢性腹膜透析（PD）患者血清TC和甘油三酯与临床结局的相关性。
对来自美国肾脏数据系统（USRDS）前瞻性透析发病率和死亡率研究第2波的1053例PD患者的数据进行了分析。采用Cox回归评估血脂水平与死亡率之间的关系。
与参考值176 - 225 mg/dl（4.54 - 5.83 mmol/l）相比，TC水平≤125 mg/dl（3.24 mmol/l）的患者全因死亡风险显著增加，包括正在服用或未服用调脂药物的患者。在分层分析中，这种关联在血清白蛋白>3.0 g/dl（30 g/l）的患者中得到证实，但在白蛋白≤3.0 g/dl的患者中未得到证实。与甘油三酯水平为201 - 300 mg/dl（2.27 - 3.39 mmol/l）的患者相比，甘油三酯水平为101 - 200 mg/dl（1.14 - 2.26 mmol/l）的患者全因死亡率显著降低，但心血管死亡率未降低，血清白蛋白水平<3.0 g/dl（30 g/l）且甘油三酯≤100 mg/dl（1.13 mmol/l）和101 - 200 mg/dl（1.14 - 2.26 mmol/l）的亚组患者也是如此。
虽然尚未明确确定混杂因素和因果途径，但本研究不支持对PD患者积极降低血浆胆固醇，然而，甘油三酯水平>200 mg/dl（2.26 mmol/l）时，可能需要治疗高甘油三酯血症。
