Kawachi Keiko, Kataoka Hiroshi, Manabe Shun, Mochizuki Toshio, Nitta Kosaku
Department of Medicine, Kidney Center, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
Clinical Research Division for Polycystic Kidney Disease, Department of Medicine, Kidney Center, Tokyo Women's Medical University, Tokyo, Japan.
Heart Vessels. 2019 Sep;34(9):1440-1455. doi: 10.1007/s00380-019-01375-4. Epub 2019 Mar 14.
Emerging epidemiological evidence indicates that low serum high-density lipoprotein cholesterol (HDL-C) levels are associated with the risk of progression of chronic kidney disease (CKD). However, the differences in the influence of serum HDL-C levels on CKD progression in different subcohorts have rarely been examined in detail in previous studies. The aim of this study was to investigate the significance of low serum HDL-C levels as a predictor of disease progression in CKD patients according to sub-analyses using a cross-classified subcohort. We reviewed data obtained from 120 CKD patients. Prognostic factors for renal outcome were identified by the multivariate Cox proportional hazards method. Kaplan-Meier analysis was performed to assess disease progression, which was defined as a > 30% decline in the glomerular filtration rate (GFR), or end-stage renal disease. The mean age of the included participants was 58.3 ± 13.6 years. The subjects were divided into two groups (low HDL-C vs. high HDL-C). The median follow-up period was 112.8 months. The kidney survival rate in the low HDL-C group was significantly lower than that in the high HDL-C group (P < 0.0001). However, the age-stratified analysis showed no difference between the two groups in the cohort of patients ≥ 70 years old. Multivariate Cox regression analyses showed a significant association between low HDL-C [hazard ratio (HR) 4.80, P = 0.009] and a ≥ 30% eGFR decline or ESRD. This association was more evident in the cohort of patients < 70 years old (HR 4.96, P = 0.0165), especially the female subcohort (HR 13.86, P = 0.0033). Multivariate analysis showed a significant correlation between visceral fat area and serum HDL-C levels among both male (P = 0.0017) and female (P = 0.0449) patients. In a propensity score-matched cohort (patients < 70 years old), the kidney survival rate of CKD patients was significantly lower in the low HDL-C group than in the high HDL-C group (P = 0.0364). A low serum HDL-C level is a significant predictor of CKD progression, especially in female patients with CKD under 70 years of age. This finding is of importance to clinicians when determining the expected prognosis of CKD in patients.
新出现的流行病学证据表明,血清高密度脂蛋白胆固醇(HDL-C)水平低与慢性肾脏病(CKD)进展风险相关。然而,既往研究很少详细探讨血清HDL-C水平对不同亚组CKD进展影响的差异。本研究旨在根据交叉分类亚组分析,探讨低血清HDL-C水平作为CKD患者疾病进展预测指标的意义。我们回顾了120例CKD患者的数据。通过多变量Cox比例风险法确定肾脏预后的预测因素。采用Kaplan-Meier分析评估疾病进展,疾病进展定义为肾小球滤过率(GFR)下降>30%或终末期肾病。纳入参与者的平均年龄为58.3±13.6岁。受试者分为两组(低HDL-C组与高HDL-C组)。中位随访期为112.8个月。低HDL-C组的肾脏生存率显著低于高HDL-C组(P<0.0001)。然而,年龄分层分析显示,在≥70岁的患者队列中,两组之间没有差异。多变量Cox回归分析显示,低HDL-C[风险比(HR)4.80,P=0.009]与eGFR下降≥30%或终末期肾病之间存在显著关联。这种关联在<70岁的患者队列中更为明显(HR 4.96,P=0.0165),尤其是女性亚组(HR 13.86,P=0.0033)。多变量分析显示,男性(P=0.0017)和女性(P=0.0449)患者的内脏脂肪面积与血清HDL-C水平之间存在显著相关性。在倾向评分匹配队列(<70岁患者)中,低HDL-C组CKD患者的肾脏生存率显著低于高HDL-C组(P=0.0364)。低血清HDL-C水平是CKD进展的重要预测指标,尤其是在70岁以下的女性CKD患者中。这一发现对临床医生判断CKD患者的预期预后具有重要意义。