Kidney Week

Abstract: SA-OR060

HDL Cholesterol and Its Associations with Cause-Specific Mortality in Patients with CKD

Session Information

• The Slow Burn: CKD Incidence and Progression
  November 04, 2017 | Location: Room 277, Morial Convention Center
  Abstract Time: 06:18 PM - 06:30 PM

Category: Chronic Kidney Disease (Non-Dialysis)

• 303 CKD: Epidemiology, Outcomes - Cardiovascular

Authors

• Navaneethan, Sankar D., Baylor College of Medicine, Houston, Texas, United States

Sankar D. Navaneethan, MD, MS, MPH, FASN

• Schold, Jesse D., Cleveland Clinic, Cleveland, Ohio, United States

Jesse D. Schold,

• Arrigain, Susana, Cleveland Clinic, Cleveland, Ohio, United States

Susana Arrigain,

• Jolly, Stacey, Cleveland Clinic, Cleveland, Ohio, United States

Stacey Jolly,

• Walther, Carl P., Baylor College of Medicine, Houston, Texas, United States

Carl P. Walther,

• Winkelmayer, Wolfgang C., Baylor College of Medicine, Houston, Texas, United States

Wolfgang C. Winkelmayer,

• Nally, Joseph V., Cleveland Clinic, Cleveland, Ohio, United States

Joseph V. Nally,

Background

Recent data suggest a U-shaped association between HDL cholesterol (HDL-c) and death in CKD. However, whether the increased mortality in patients with extreme levels is driven by specific causes of death remains unclear. Herein, we examined the associations between HDL-c and cause-specific mortality in a large CKD population.

Methods

We included 38,377 patients with eGFR 15-59 ml/min/1.73 m² who had lipid levels measured within 1 year of CKD diagnosis. We ascertained overall and cause-specific deaths from the State mortality data and classified deaths into 3 major categories: a) cardiovascular; b) malignancy; and c) non-cardiovascular/non-malignancy causes. We fitted Cox regression models for overall mortality and separate competing risk models for each major cause of death category to evaluate their respective associations with categories of HDL-c (≤30, 31-40, 41-50 [referent], 51-60, >60 mg/dl). Separate analyses were conducted for men and women.

Results

During a median follow-up of 4.5 years, 9,665 patients died. HDL-c ≤30 mg/dl was associated with higher risk of all-cause and cardiovascular mortality in both sexes and higher risk of malignancy-related deaths in women (Table 1). HDL-c >60 mg/dl was associated with lower all-cause mortality in women only. HDL-c >60 mg/dl was associated with higher risk of non-cardiovascular/non-malignancy related deaths in men but not women. Exclusion of those with maligancy yielded results similar to primary analyses.

Conclusion

In a non-dialysis dependent CKD population, HDL-c ≤30 mg/dl was associated with higher all-cause and cardiovascular mortality, but not with non-cardiovascular mortality. HDL-c >60 mg/dl was associated with higher risk of non-cardiovascular/non-malignancy related deaths in men only. Additional studies examining the reasons for these different associations between HDL-c and cause-specific mortality, and potential effect modification by sex, are needed.

Funding

• Commercial Support – Development of CCF CKD registry was suppoerted by an unrestricted educational fund to the Department of Nephrology and Hypertension from Amgen, Inc