在腹膜透析患者中，残余胆固醇比低密度脂蛋白胆固醇更能预测心血管死亡率。

Remnant cholesterol predicts cardiovascular mortality beyond low-density lipoprotein cholesterol in patients with peritoneal dialysis.

作者信息

Guo Jing, Peng Yuan, Liu Ruihua, Yi Chunyan, Guo Qunying, Yang Xiao

机构信息

Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China (Drs Guo, Peng, Liu, Yi, Guo and Yang); NHC Key Laboratory of Clinical Nephrology (Sun Yat-Sen University) and Guangdong Provincial Key Laboratory of Nephrology, Guangzhou 510080, China (Drs Guo, Peng, Liu, Yi, Guo and Yang); Department of Nephrology, Ganzhou People's Hospital (The First Affiliated Ganzhou Hospital of Nanchang University), Ganzhou 341000, China (Dr Peng).

出版信息

J Clin Lipidol. 2023 Nov-Dec;17(6):708-716. doi: 10.1016/j.jacl.2023.09.004. Epub 2023 Sep 9.

DOI:10.1016/j.jacl.2023.09.004

PMID:37723014

Abstract

BACKGROUND

Patients undergoing peritoneal dialysis (PD) are prone to dyslipidemia. However, studies concerning remnant cholesterol (RC) in such patients are limited.

OBJECTIVE

We aimed to investigate the association between RC and cardiovascular (CV) mortality in patients on PD.

METHODS

Patients who initiated PD at our center (2006-2018) were retrospectively enrolled. Adjusted Cox models were used to evaluate the independent association between baseline RC levels and CV mortality. We classified patients into 4 concordant/discordant categories according to their baseline lipid profiles. Cox models were then used to determine the association between different low-density lipoprotein cholesterol (LDL-C) and RC levels and CV mortality risk.

RESULTS

The study enrolled 2333 individuals, with a mean RC of 33.4 mg/dL. RC levels were positively associated with CV mortality risk independent of LDL-C in patients on PD (hazard ratio [HR]: 1.05; 95% confidence interval [CI]: 1. 00-1.10). In the concordant/discordant categories, patients with high LDL-C and RC levels had a higher CV mortality risk (HR: 1.52; 95% CI: 1.01-2.28) than those with low LDL-C and RC levels in the entire cohort. Moreover, in older patients, a higher RC level increased CV mortality risk regardless of the LDL-C level (HR: 2.41, 95% CI: 1.22-4.74; HR: 2.15, 95% CI: 1.12-4.14).

CONCLUSIONS

RC levels are elevated in patients on PD and can predict CV mortality beyond LDL-C levels. RC levels should be considered alongside LDL-C levels when assessing prognostic lipid levels in these patients. More attention should be given to RC than to LDL-C in older patients undergoing PD.

摘要

背景

接受腹膜透析（PD）的患者易患血脂异常。然而，关于此类患者残余胆固醇（RC）的研究有限。

目的

我们旨在研究PD患者中RC与心血管（CV）死亡率之间的关联。

方法

回顾性纳入在我们中心（2006 - 2018年）开始PD治疗的患者。采用校正的Cox模型评估基线RC水平与CV死亡率之间的独立关联。根据患者的基线血脂谱将其分为4个一致/不一致类别。然后使用Cox模型确定不同的低密度脂蛋白胆固醇（LDL-C）和RC水平与CV死亡风险之间的关联。

结果

该研究纳入了2333名个体，平均RC为33.4mg/dL。在PD患者中，RC水平与CV死亡风险呈正相关，且独立于LDL-C（风险比[HR]：1.05；95%置信区间[CI]：1.00 - 1.10）。在一致/不一致类别中，整个队列中LDL-C和RC水平高的患者比LDL-C和RC水平低的患者具有更高的CV死亡风险（HR：1.52；95%CI：1.01 - 2.28）。此外，在老年患者中，无论LDL-C水平如何，较高的RC水平都会增加CV死亡风险（HR：2.41，95%CI：1.22 - 4.74；HR：2.15，95%CI：1.12 - 4.14）。