Wu Xianfeng, Zhou Lei, Zhan Xiaojiang, Wen Yueqiang, Wang Xiaoyang, Feng Xiaoran, Wang Niansong, Peng Fenfen, Wu Junnan
Department of Nephrology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
Clinical Research Center for Chronic Kidney Disease, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
Front Nutr. 2022 Jul 21;9:910348. doi: 10.3389/fnut.2022.910348. eCollection 2022.
In dialysis patients, lowering low-density lipoprotein cholesterol (LDL-C) did not provide benefits, which seemed implausible in clinical practice. We hypothesized a U-shaped association between LDL-C and mortality in dialysis patients.
In this multi-center retrospective real-world cohort study, 3,565 incident Chinese peritoneal dialysis (PD) patients between January 1, 2005, and May 31, 2020, were included. The associations between baseline LDL-C and mortality were examined using cause-specific hazard models.
Of 3,565 patients, 820 died, including 415 cardiovascular deaths. As compared with the reference range (2.26-2.60 mmol/L), both higher levels of LDL-C (> 2.60 mmol/L) and lower levels of LDL-C (< 2.26 mmol/L) were associated with increased risks of all-cause mortality (hazard ratio [HR],1.35, 95% confidence index [CI], 1.09-1.66; HR 1.36, 95%CI, 1.13-1.64) and cardiovascular mortality (HR, 1.31, 95% CI, 1.10-1.72; HR, 1.64; 95% CI, 1.22-2.19). Malnutrition (albumin < 36.0 g/L) modified the association between LDL-C and cardiovascular mortality (P for interaction = 0.01). A significantly increased risk of cardiovascular mortality was observed among patients with malnutrition and lower levels of LDL-C (HR 2.96, 95%CI 1.43-6.12) or higher levels of LDL-C (HR 2.81, 95%CI 1.38-5.72).
Low and high levels of LDL-C at the start of PD procedure were associated with increased all-cause and cardiovascular mortality risks. Malnutrition may modify the association of LDL-C with cardiovascular mortality.
在透析患者中，降低低密度脂蛋白胆固醇（LDL-C）并未带来益处，这在临床实践中似乎难以置信。我们推测透析患者的LDL-C与死亡率之间呈U形关联。
在这项多中心回顾性真实世界队列研究中，纳入了2005年1月1日至2020年5月31日期间的3565例中国新发病例腹膜透析（PD）患者。使用特定病因风险模型研究基线LDL-C与死亡率之间的关联。
在3565例患者中，820例死亡，其中415例死于心血管疾病。与参考范围（2.26 - 2.60 mmol/L）相比，较高水平的LDL-C（> 2.60 mmol/L）和较低水平的LDL-C（< 2.26 mmol/L）均与全因死亡率增加风险相关（风险比[HR]，1.35，95%置信区间[CI]，1.09 - 1.66；HR 1.36，95%CI，1.13 - 1.64）以及心血管死亡率增加风险相关（HR，1.31，95%CI，1.10 - 1.72；HR，1.64；95%CI，1.22 - 2.19）。营养不良（白蛋白< 36.0 g/L）改变了LDL-C与心血管死亡率之间的关联（交互作用P = 0.01）。在营养不良且LDL-C水平较低（HR 2.96，95%CI 1.43 - 6.12）或较高（HR 2.81，95%CI 1.38 - 5.72）的患者中，观察到心血管死亡率风险显著增加。
PD治疗开始时LDL-C水平过低和过高均与全因死亡率和心血管死亡率增加风险相关。营养不良可能会改变LDL-C与心血管死亡率之间的关联。
