Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan;, †Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan, ‡Faculties of Medicine and, §Renal Care, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
Clin J Am Soc Nephrol. 2013 Nov;8(11):1915-26. doi: 10.2215/CJN.02350213. Epub 2013 Aug 8.
Malnutrition and/or inflammation may modify the risk relationship of total cholesterol with cardiovascular disease in CKD patients. However, it is unclear whether the relationship of total cholesterol with cardiovascular events and mortality varies by proteinuria.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: This study enrolled 3303 patients with CKD stages 3-5 from a medical center and a regional hospital between November of 2002 and May of 2009 and followed the patients until July of 2010.
During a median 2.8-year follow-up, there were 471 (14.3%) deaths and 545 (16.5%) cardiovascular events. In an adjusted Cox model, the two highest quartiles of total cholesterol (hazard ratio, 1.90; 95% confidence interval, 1.16 to 3.13 and hazard ratio, 2.00; 95% confidence interval, 1.18 to 3.39 versus quartile 1, respectively) were associated with a significant higher risk of all-cause mortality in patients with urine protein-to-creatinine ratio<1 g/g (n=1535), but this higher risk was not seen in those patients with urine protein-to-creatinine ratio ≥ 1 g/g (n=1768; hazard ratio, 0.75; 95% confidence interval, 0.53 to 1.07 and hazard ratio, 0.70; 95% confidence interval, 0.49 to 1.02 versus quartile 1, respectively). The interaction between total cholesterol and proteinuria with all-cause mortality was significant (interaction, P=0.05). However, the relationship between total cholesterol and cardiovascular events did not significantly differ by proteinuria (interaction, P=0.91).
The association between cholesterol and mortality is different among patients with different levels of proteinuria. Large-scale clinical trials to evaluate the mortality benefit should specifically target lowering hypercholesterolemia in CKD patients with different levels of proteinuria.
营养不良和/或炎症可能会改变慢性肾脏病（CKD）患者的总胆固醇与心血管疾病风险之间的关系。然而，总胆固醇与心血管事件和死亡率的关系是否因蛋白尿而异尚不清楚。
设计、地点、参与者和测量方法：这项研究纳入了 2002 年 11 月至 2009 年 5 月期间来自一家医学中心和一家地区医院的 3303 名 CKD 3-5 期患者，并对这些患者进行了随访，直至 2010 年 7 月。
在中位 2.8 年的随访期间，共有 471 例（14.3%）死亡和 545 例（16.5%）心血管事件。在调整后的 Cox 模型中，总胆固醇最高的两个四分位数（危险比，1.90；95%置信区间，1.16 至 3.13 和危险比，2.00；95%置信区间，1.18 至 3.39 与四分位 1 相比）与尿蛋白/肌酐比值<1 g/g（n=1535）患者的全因死亡率显著升高相关，但在尿蛋白/肌酐比值≥1 g/g（n=1768）的患者中未观察到这种高风险（危险比，0.75；95%置信区间，0.53 至 1.07 和危险比，0.70；95%置信区间，0.49 至 1.02 与四分位 1 相比）。总胆固醇和蛋白尿与全因死亡率之间的交互作用具有统计学意义（交互作用，P=0.05）。然而，总胆固醇与心血管事件的关系在蛋白尿水平不同的患者中没有显著差异（交互作用，P=0.91）。
胆固醇与死亡率之间的关系在不同蛋白尿水平的患者中有所不同。评估死亡率获益的大型临床试验应特别针对不同蛋白尿水平的 CKD 患者降低高胆固醇血症。
