Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
National Clinical Research Center for Kidney Disease, Guangzhou, China.
Ren Fail. 2024 Dec;46(1):2334912. doi: 10.1080/0886022X.2024.2334912. Epub 2024 Apr 11.
The relationship between serum total cholesterol (TC) and triglyceride (TG) levels and mortality in maintenance hemodialysis (MHD) patients remains inconsistent. We aimed to explore the individual and combined association of TC and TG levels with the risk of mortality in Chinese MHD patients.
1036 MHD patients were enrolled in this multicenter, prospective cohort study. The serum levels of total cholesterol and triglycerides were measured at baseline. The primary outcome was all-cause mortality and secondary outcome was cardiovascular disease (CVD) mortality.
During a median follow-up duration of 4.4 years (IQR= 2.0-7.9 years), 549 (53.0%) patients died, and 297 (28.7%) deaths were attributed to CVD. Compared with patients with TC levels in the first three quartiles (<182.5 mg/dL), a significantly higher risk of all-cause mortality was found in participants with TC in the fourth quartile (hazard ratio [HR], 1.43; 95% confidence interval [CI], 1.17-1.76). However, a significantly lower risk of all-cause mortality was observed in participants with TG in the fourth quartile (≥193.9 mg/dL) (HR, 0.78; 95%CI: 0.63-0.98), compared with participants with TG in the first three quartiles. Similar trends were observed in CVD mortality. When analyzed jointly, patients with lower TC (<182.5 mg/dL) and higher TG (≥193.9 mg/dL) levels had the lowest risk of all-cause mortality and CVD mortality. In MHD patients in southern China, higher TC levels were associated with higher risk of mortality, while higher TG levels were related to lower risk of mortality. Patients with lower TC and higher TG levels had the best survival prognosis.
维持性血液透析（MHD）患者血清总胆固醇（TC）和甘油三酯（TG）水平与死亡率之间的关系尚不一致。本研究旨在探讨 TC 和 TG 水平与中国 MHD 患者死亡风险的个体和联合关联。
这项多中心前瞻性队列研究纳入了 1036 名 MHD 患者。在基线时测量了总胆固醇和甘油三酯的血清水平。主要结局为全因死亡率，次要结局为心血管疾病（CVD）死亡率。
在中位随访 4.4 年（IQR=2.0-7.9 年）期间，549 名（53.0%）患者死亡，297 名（28.7%）死亡归因于 CVD。与 TC 水平在前三个四分位数（<182.5mg/dL）的患者相比，TC 水平在第四个四分位数（四分位距 [IQR]，182.5-226.2mg/dL）的患者发生全因死亡的风险显著更高（风险比 [HR]，1.43；95%置信区间 [CI]，1.17-1.76）。然而，与 TC 在前三个四分位数的患者相比，TG 水平在第四个四分位数（≥193.9mg/dL）的患者发生全因死亡的风险显著更低（HR，0.78；95%CI：0.63-0.98）。在 CVD 死亡率方面也观察到了类似的趋势。当联合分析时，TC 水平较低（<182.5mg/dL）和 TG 水平较高（≥193.9mg/dL）的患者全因死亡率和 CVD 死亡率最低。在中国南方的 MHD 患者中，较高的 TC 水平与较高的死亡率相关，而较高的 TG 水平与较低的死亡率相关。TC 和 TG 水平较低的患者具有最佳的生存预后。
