Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China; Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangzhou, China.
Department of Medical Statistics, Clinical Trials Unit, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
Can J Cardiol. 2020 Jan;36(1):92-99. doi: 10.1016/j.cjca.2019.08.028. Epub 2019 Aug 29.
In peritoneal dialysis (PD), the relationship among low-density lipoprotein cholesterol (LDL-C), peritonitis, and cardiovascular (CV) disease has not been clarified. This study was performed to explore their associations in a large PD cohort.
This retrospective cohort study included incident patients who received PD catheter insertion in our centre. The primary outcome was the first CV event (nonfatal myocardial infarction, CV death, non-haemorrhagic stroke, or any arterial revascularization procedure). Secondary outcomes were the occurrence of peritonitis, CV mortality, and all-cause mortality.
This study included 1294 patients, whose mean age was 48.1 years. After adjustment for confounders in negative binomial regression models, lower LDL-C quartiles were independently associated with a higher risk of peritonitis, compared with the highest quartile. The multivariate competing risk model showed no significant association between baseline LDL-C and the first CV event in the overall population. However, stratified analysis showed that each 1 mmol/L increase in LDL-C was independently associated with a 21% (subdistribution hazard ratio: 1.21, 95% confidence interval: 1.06-1.39) increased risk of the first CV event among peritonitis-free patients, and with a 20% (subdistribution hazard ratio: 0.80, 95% confidence interval: 0.65-0.99) decreased risk among patients with peritonitis. Moderating-effect analysis showed that the presence of peritonitis significantly influenced the relationships between LDL-C and CV events (P < 0.001). Similar results were also observed in the relationship between LDL-C and mortality.
PD patients with lower baseline LDL-C had a higher risk of peritonitis. The effect of LDL-C on CV events and mortality was different by the presence of peritonitis events.
在腹膜透析（PD）中，低密度脂蛋白胆固醇（LDL-C）、腹膜炎和心血管（CV）疾病之间的关系尚未明确。本研究旨在探讨大型 PD 队列中它们之间的关联。
这是一项回顾性队列研究，纳入了在我院接受 PD 导管插入术的新发患者。主要结局是首次 CV 事件（非致死性心肌梗死、CV 死亡、非出血性卒中和任何动脉血运重建手术）。次要结局为腹膜炎、CV 死亡率和全因死亡率的发生。
本研究纳入了 1294 例患者，平均年龄为 48.1 岁。在负二项回归模型中调整混杂因素后，与最高四分位相比，较低的 LDL-C 四分位数与腹膜炎风险升高独立相关。多变量竞争风险模型显示，在总体人群中，基线 LDL-C 与首次 CV 事件之间无显著关联。然而，分层分析显示，在腹膜炎患者中，LDL-C 每增加 1mmol/L，首次 CV 事件的风险增加 21%（亚分布风险比：1.21，95%置信区间：1.06-1.39），在无腹膜炎患者中，LDL-C 每增加 1mmol/L，首次 CV 事件的风险降低 20%（亚分布风险比：0.80，95%置信区间：0.65-0.99）。调节效应分析表明，腹膜炎的存在显著影响了 LDL-C 与 CV 事件之间的关系（P < 0.001）。在 LDL-C 与死亡率之间的关系中也观察到了类似的结果。
PD 患者基线 LDL-C 较低，腹膜炎风险较高。腹膜炎的发生与否对 LDL-C 与 CV 事件和死亡率的影响不同。
