Kidney Week

Abstract: TH-PO161

Dyslipidemia and Outcomes in NEPTUNE

Session Information

• Clinical Glomerular Disorders: FSGS, MN, MCD
  November 02, 2017 | Location: Hall H, Morial Convention Center
  Abstract Time: 10:00 AM - 10:00 AM

Category: Glomerular

• 1005 Clinical Glomerular Disorders

Authors

• Sethna, Christine B., Cohen Children's Medical Center of NY, New Hyde Park, New York, United States

Christine B. Sethna,

• Meyers, Kevin E.C., The Children Hospital of Philadelphia and University of Pennsylvania, Philadelphia, Pennsylvania, United States

Kevin E.C. Meyers,

• Brady, Tammy M., Johns Hopkins University , Baltimore, Maryland, United States

Tammy M. Brady,

• Gadegbeku, Crystal A., Temple University, Philadelphia, Pennsylvania, United States

Crystal A. Gadegbeku,

• Srivastava, Tarak, Childrens's Mercy Hospital, Kansas City, Missouri, United States

Tarak Srivastava,

• Gibson, Keisha L., University of North Carolina Kidney Center, Chapel Hill, North Carolina, United States

Keisha L. Gibson,

• Kretzler, Matthias, U.Michigan, Ann Arbor, Michigan, United States

Matthias Kretzler,

• Mariani, Laura H., University of Michigan, Ann Arbor, Michigan, United States

Laura H. Mariani,

Group or Team Name

• NEPTUNE Cardiovascular Working Group

Background

Patients with nephrotic syndrome (NS) have a pronounced alteration in lipoprotein metabolism. Dyslipidemia is a major risk factor for cardiovascular disease and may be associated with progression of renal disease; however, this has not been well characterized in NS.

Methods

Baseline lipid studies from the Nephrotic Syndrome Study Network (NEPTUNE) were collected. Dyslipidemia was defined as total cholesterol ≥200 mg/dL, HDL <40 mg/dL, LDL ≥130 mg/dL or triglycerides ≥100 mg/dL (0-9 yr), ≥130 mg/dL (10-17 yr), ≥50 mg/dL (≥18 yr). Cox regression adjusted for age, sex, race, disease, disease duration, baseline eGFR and urine protein:creatinine [UPC] examined the association of lipids (per 10 unit increase) with the Composite Outcome (End Stage Renal Disease or eGFR decline by ≥40%) and first Complete Remission (UPC <0.3).

Results

271 adults (45.4±16.1 yr, 62% M) and 123 children (10.2±4.8 yr, 59% M) were evaluated. At baseline, 85% of participants had dyslipidemia (table). In the overall group, lower HDL and greater triglycerides were associated with increased hazard of the composite outcome (HR 0.91, 95%CI 0.83-0.98, p=0.02 and HR 1.02, 95%CI 1.001-1.03, p=0.001, respectively). Greater HDL (HR 1.05, 95%CI 1.001-1.1, p=0.045) was associated with increased hazard of Complete Remission. Similar relationships were found in adults for Composite Outcome (HDL: HR 0.88, 95%CI 0.79-0.98, p=0.03; triglycerides: HR 1.01, 95%CI 1.001-1.03, p=0.04) and Complete Remission (HDL: HR 1.1, 95%CI 1.03-1.18, p=0.006). In children, greater triglycerides (HR 1.05, 95%CI 1.02-1.08, p=0.001) were associated with increased hazard of the Composite Endpoint. Lipids were not associated with Complete Remission.

Conclusion

In NEPTUNE, dyslipidemia is common and is an independent predictor of renal outcomes.

Funding

• NIDDK Support