Department of General Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
Sci Rep. 2020 Jul 29;10(1):12749. doi: 10.1038/s41598-020-69794-2.
Dyslipidemia is common in patients with chronic kidney disease (CKD), however the relationship between dyslipidemia and mortality in patients with moderate to severe CKD remains controversial. Non-high-density lipoprotein (HDL) cholesterol has been reported to be a more accurate predictor of clinical outcomes than conventional lipid measurements. Hence, the aim of this study was to investigate associations between non-HDL cholesterol and the risk of overall and cardiovascular mortality in patients with CKD stage 3-5. We enrolled 429 pre-dialysis patients with stage 3 to 5 CKD from May 2006 to January 2010. The patients were divided into four groups according to quartiles of non-HDL cholesterol. The patients were followed until death or until January 2020. During a median 11.6 years of follow-up, there were 78 (18.2%) deaths overall and 32 (7.5%) cardiovascular deaths. In adjusted models, the patients in quartile 1 (hazard ratio [HR] 3.368; 95% confidence interval [CI] 1.388-8.176; p = 0.007), quartile 3 (HR 3.666; 95% CI 1.486-9.044; p = 0.005), and quartile 4 (HR 2.868; 95% CI 1.136-7.240; p = 0.026) of non-HDL cholesterol had a higher risk of overall mortality (vs. quartile 2). In addition, the patients in quartile 1 (HR 19.503; 95% CI 2.185-174.0925 p = 0.008), quartile 3 (HR 28.702; 95% CI 2.990-275.559; p = 0.004), and quartile 4 (HR 11.136; 95% CI 1.126-110.108; p = 0.039) had a higher risk of cardiovascular mortality (vs. quartile 2). Our study showed a U-shaped relationship between non-HDL cholesterol and the risk of overall and cardiovascular mortality in patients with CKD stage 3-5. Assessing non-HDL cholesterol may help to identify subjects at high-risk of adverse outcomes.
血脂异常在慢性肾脏病（CKD）患者中很常见，但血脂异常与中重度 CKD 患者的死亡率之间的关系仍存在争议。非高密度脂蛋白（HDL）胆固醇已被报道为比传统脂质测量更准确的临床结局预测因子。因此，本研究旨在探讨非 HDL 胆固醇与 CKD 3-5 期患者全因和心血管死亡率风险之间的关系。我们招募了 2006 年 5 月至 2010 年 1 月期间来自 CKD 3-5 期的 429 名未透析患者。根据非 HDL 胆固醇的四分位距将患者分为四组。患者随访至死亡或至 2020 年 1 月。在中位 11.6 年的随访期间，共有 78 例（18.2%）患者发生全因死亡，32 例（7.5%）患者发生心血管死亡。在调整后的模型中，非 HDL 胆固醇第 1 四分位数组（风险比[HR]3.368；95%置信区间[CI]1.388-8.176；p=0.007）、第 3 四分位数组（HR3.666；95%CI1.486-9.044；p=0.005）和第 4 四分位数组（HR2.868；95%CI1.136-7.240；p=0.026）的全因死亡风险更高（vs.第 2 四分位数组）。此外，非 HDL 胆固醇第 1 四分位数组（HR19.503；95%CI2.185-174.0925；p=0.008）、第 3 四分位数组（HR28.702；95%CI2.990-275.559；p=0.004）和第 4 四分位数组（HR11.136；95%CI1.126-110.108；p=0.039）的心血管死亡风险更高（vs.第 2 四分位数组）。我们的研究表明，非 HDL 胆固醇与 CKD 3-5 期患者全因和心血管死亡率风险之间存在 U 型关系。评估非 HDL 胆固醇可能有助于识别发生不良结局的高危患者。
