Zitnik Edward, Streja Elani, Laster Marciana
Department of Pediatrics, University of Connecticut School of Medicine, Farmington, CT 06032, USA.
Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA 90095, USA.
Nutrients. 2025 Jan 27;17(3):459. doi: 10.3390/nu17030459.
BACKGROUND/OBJECTIVES: Children on dialysis have a 10-fold increase in cardiovascular disease (CVD)-related mortality when compared to the general population. The development of CVD in dialysis patients is attributed to Chronic Kidney Disease-Mineral Bone Disorder (CKD-MBD) and dyslipidemia. While the prevalence of dyslipidemia in adult dialysis patients has been described, there are limited data on prevalence, severity, and risk factors for pediatric dyslipidemia.
Data from 1730 pediatric patients ≤ 21 years receiving maintenance hemodialysis or peritoneal dialysis with at least one lipid panel measurement were obtained from USRDS between 2001 and 2016. Disease etiology was classified as being glomerular ( = 1029) or non-glomerular ( = 701). Comparisons were made across etiologies using both linear and logistic regression models to determine the relationship between disease etiology and lipid levels.
The cohort had a mean age of 15.2 years and were 54.5% female. Adjusting for age, sex, race/ethnicity, modality, time with End Stage Kidney Disease (ESKD), and body mass index (BMI) and using non-glomerular etiology as the reference, glomerular disease [mean (95% CI)] was associated with +19% (+14.7%, +23.8%) higher total cholesterol level (183 mg/dL vs. 162 mg/dL), +21% (+14.8%, +26.6%) higher low density lipoprotein cholesterol level (108 mg/dL vs. 87 mg/dL), and +22.3% (+15.5%, +29.5%) higher triglyceride level (169 mg/dL vs. 147 mg/dL). Glomerular disease [OR (95% CI)] was associated with 3.0-fold [2.4, 3.9] higher odds of having an abnormal total cholesterol level, 3.8-fold [2.8, 5.0] higher odds of having an abnormal LDL-C level, and 1.9-fold [1.5, 2.4] higher odds of having an abnormal triglyceride level when compared to non-glomerular disease.
Pediatric dialysis patients have a high prevalence of dyslipidemia, particularly from elevated triglyceride levels. Specifically, patients with glomerular disease have an even higher risk of dyslipidemia from elevated non-HDL cholesterol and triglyceride levels than patients with non-glomerular disease. The long-term impact of this unfavorable lipid profile requires further investigation.
背景/目的：与普通人群相比，接受透析治疗的儿童心血管疾病（CVD）相关死亡率增加了10倍。透析患者CVD的发生归因于慢性肾脏病-矿物质和骨代谢紊乱（CKD-MBD）和血脂异常。虽然已有关于成人透析患者血脂异常患病率的描述，但关于儿童血脂异常的患病率、严重程度和危险因素的数据有限。
从美国肾脏数据系统（USRDS）获取2001年至2016年间1730例年龄≤21岁接受维持性血液透析或腹膜透析且至少有一次血脂检测结果的儿科患者的数据。疾病病因分为肾小球性（n = 1029）或非肾小球性（n = 701）。使用线性和逻辑回归模型对不同病因进行比较，以确定疾病病因与血脂水平之间的关系。
该队列的平均年龄为15.2岁，女性占54.5%。在调整年龄、性别、种族/民族、透析方式、终末期肾病（ESKD）病程和体重指数（BMI）后，以非肾小球性病因作为参照，肾小球疾病[均值（95%置信区间）]与总胆固醇水平升高19%（+14.7%，+23.8%）（183mg/dL对162mg/dL）、低密度脂蛋白胆固醇水平升高21%（+14.8%，+26.6%）（108mg/dL对87mg/dL）以及甘油三酯水平升高22.3%（+15.5%，+29.5%）（169mg/dL对147mg/dL）相关。与非肾小球疾病相比，肾小球疾病[比值比（95%置信区间）]与总胆固醇水平异常的 odds 比高3.0倍[2.4, 3.9]、低密度脂蛋白胆固醇水平异常的 odds 比高3.8倍[2.8, 5.0]以及甘油三酯水平异常的 odds 比高1.9倍[1.5, 2.4]相关。
儿科透析患者血脂异常患病率较高，尤其是甘油三酯水平升高。具体而言，与非肾小球疾病患者相比，肾小球疾病患者因非高密度脂蛋白胆固醇和甘油三酯水平升高而发生血脂异常的风险更高。这种不利血脂谱的长期影响需要进一步研究。
