Goldfarb-Rumyantzev Alexander S, Habib Arsalan N, Baird Bradley C, Barenbaum Lev L, Cheung Alfred K
Division of Nephrology and Hypertension, University of Utah School of Medicine, Salt Lake City, UT, USA.
Am J Kidney Dis. 2007 Nov;50(5):791-802. doi: 10.1053/j.ajkd.2007.07.023.
The effect of lipid-lowering therapy on clinical outcomes in peritoneal dialysis patients has not been carefully addressed.
Secondary analysis of a retrospective cohort study.
SETTING & PARTICIPANTS: Data from 1,053 incident peritoneal dialysis patients from the US Renal Data System prospective Dialysis Morbidity and Mortality Wave 2 study.
Use of lipid-modifying medications (93% statins, 7% other medications).
OUTCOMES & MEASUREMENTS: Cox regression with propensity score adjustment was used to evaluate time to cardiovascular or all-cause mortality during a 2-year follow-up period. Subgroups based on predefined cutoff values for serum total cholesterol or triglycerides, presence of diabetes, and comorbidity index were analyzed separately.
Use of lipid-modifying medications was associated with decreased all-cause (hazard ratio [HR], 0.74; 95% confidence interval, 0.56 to 0.98) and cardiovascular (HR, 0.67; 95% confidence interval, 0.47 to 0.95) mortality compared with no use of lipid-modifying medications. In subgroup analyses, use of lipid-modifying medications was associated with decreased all-cause mortality (HR, 0.46; 95% confidence interval, 0.22 to 0.95) in the subgroups with cholesterol levels of 226 to 275 mg/dL (HR, 0.27; 95% confidence interval, 0.09 to 0.80) and cholesterol levels greater than 275 mg/dL and cardiovascular mortality (HR, 0.31; 95% confidence interval, 0.11 to 0.85) in the subgroup with cholesterol levels of 226 to 275 mg/dL. Use of lipid-modifying medications also was associated with decreased cardiovascular mortality (HR, 0.64; 95% confidence interval, 0.41 to 0.99) in patients with diabetes and decreased all-cause (HR, 0.65; 95% confidence interval, 0.45 to 0.94) and cardiovascular mortality (HR, 0.55; 95% confidence interval, 0.35 to 0.87) in those with Charlson Comorbidity Index score higher than 2.
Observational study with retrospective design. Considerable amount of missing data and limited amount of information for the extreme values of cholesterol and triglycerides.
These observational data suggest that lipid-modifying medication therapy may be associated with improved clinical outcomes in peritoneal dialysis patients.
降脂治疗对腹膜透析患者临床结局的影响尚未得到充分研究。
一项回顾性队列研究的二次分析。
来自美国肾脏数据系统前瞻性透析发病率和死亡率第2波研究的1053例新发腹膜透析患者的数据。
使用调脂药物（93%为他汀类药物，7%为其他药物）。
采用倾向评分调整的Cox回归分析，评估2年随访期内心血管或全因死亡率。根据血清总胆固醇或甘油三酯的预定义临界值、糖尿病的存在情况和合并症指数对亚组进行单独分析。
与未使用调脂药物相比，使用调脂药物与全因死亡率降低（风险比[HR]，0.74；95%置信区间，0.56至0.98）和心血管死亡率降低（HR，0.67；95%置信区间，0.47至0.95）相关。在亚组分析中，在胆固醇水平为226至275mg/dL的亚组中，使用调脂药物与全因死亡率降低（HR，0.46；95%置信区间，0.22至0.95）相关，在胆固醇水平大于275mg/dL的亚组中，使用调脂药物与全因死亡率降低（HR，0.27；95%置信区间，0.09至0.80）和心血管死亡率降低（HR，0.31；95%置信区间，0.11至0.85）相关。在糖尿病患者中，使用调脂药物也与心血管死亡率降低（HR，0.64；95%置信区间，0.41至0.99）相关，在Charlson合并症指数评分高于2的患者中，使用调脂药物与全因死亡率降低（HR，0.65；95%置信区间，0.45至0.94）和心血管死亡率降低（HR，0.55；95%置信区间，0.35至0.87）相关。
回顾性设计的观察性研究。存在大量缺失数据，且胆固醇和甘油三酯极值的信息量有限。
这些观察性数据表明，调脂药物治疗可能与腹膜透析患者临床结局的改善相关。
