慢性肾脏病中低密度脂蛋白胆固醇的评估。

Estimation of LDL cholesterol in chronic kidney disease.

作者信息

Bauer Frederic, Seibert Felix S, Rohn Benjamin, Babel Nina, Westhoff Timm H

机构信息

Medical Department I, Universitätsklinikum Marien Hospital Herne, Ruhr-University of Bochum, Hölkeskampring 40, 44625 Herne, Germany.

出版信息

Eur J Prev Cardiol. 2021 Oct 13;28(12):1402-1408. doi: 10.1093/eurjpc/zwaa003.

DOI:10.1093/eurjpc/zwaa003

PMID:33624033

Abstract

AIMS

Most of the laboratories make use of the Friedewald formula to assess low-density lipoprotein cholesterol (LDL-C). The accuracy of this approach, however, crucially depends on triglyceride concentrations. Since hypertriglyceridaemia is a characteristic trait of the lipid profile in chronic kidney disease (CKD), the present study examines the accuracy of the Friedewald formula in this population. It aims to derive and validate a more accurate equation for CKD.

METHODS

Cross-sectional study on two cohorts of subjects (overall n = 3.514) with estimated glomerular filtration rate (eGFR) <60 mL/min comparing directly measured LDL-C (LDL-Cmeas) as assessed by an enzymatic assay (Roche, Switzerland) to concentrations estimated by the Friedewald (LDL-CF) and the Martin's formula (LDL-CM). Accuracy was analysed by Bland-Altman and linear regression analyses. In the first cohort, a novel formula was derived to assess LDL-C in CKD. The formula was validated in Cohort 2.

RESULTS

Cohort 1 comprised 1738 subjects, and Cohort 2 comprised 1776 subjects. The mean eGFR was 29.4 ± 14.4 mL/min. In Cohort 1, LDL-CF was highly correlated with LDL-Cmeas (R2 = 0.92) but significantly underestimated LDLmeas by 11 mg/dL. LDL-C = cholesterol - HDL - triglycerides/7.98 was derived as the optimal equation for the calculation of LDL-C in Cohort 1 and was successfully validated in Cohort 2 (bias of 1.6 mg/dL). The novel formula had a higher accuracy than both the Friedewald (bias -12.2 mg/dL) and the Martin's formula (bias -4.8 mg/dL).

CONCLUSION

The Friedewald formula yields lower LDL-C concentrations in CKD than direct enzymatic measurements, which may lead to undersupply of this cardiovascular high-risk population in a treat-to-target approach.

摘要

目的

大多数实验室使用弗瑞德沃德公式来评估低密度脂蛋白胆固醇（LDL-C）。然而，这种方法的准确性关键取决于甘油三酯浓度。由于高甘油三酯血症是慢性肾脏病（CKD）脂质谱的一个特征性表现，本研究考察了弗瑞德沃德公式在该人群中的准确性。其目的是推导并验证一个适用于CKD的更准确的公式。

方法

对两个队列的受试者（共n = 3514）进行横断面研究，这些受试者的估计肾小球滤过率（eGFR）<60 mL/min，将通过酶法测定（瑞士罗氏公司）直接测得的LDL-C（LDL-Cmeas）与用弗瑞德沃德公式（LDL-CF）和马丁公式（LDL-CM）估算的浓度进行比较。通过布兰德-奥特曼分析和线性回归分析来分析准确性。在第一个队列中，推导了一个用于评估CKD中LDL-C的新公式。该公式在队列2中进行了验证。

结果

队列1包括1738名受试者，队列2包括1776名受试者。平均eGFR为29.4±14.4 mL/min。在队列1中，LDL-CF与LDL-Cmeas高度相关（R2 = 0.92），但显著低估LDLmeas达11 mg/dL。LDL-C = 胆固醇 - HDL - 甘油三酯/7.98被推导为队列1中计算LDL-C的最佳公式，并在队列2中成功验证（偏差为1.6 mg/dL）。新公式比弗瑞德沃德公式（偏差 -12.2 mg/dL）和马丁公式（偏差 -4.8 mg/dL）具有更高的准确性。