Abstract: SA-PO151

Low Density Lipoprotein Cholesterol Is Associated with Decreased Infectious Death and Hospitalization in Hemodialysis Patients

Session Information

Category: Nutrition, Inflammation, and Metabolism

  • 1401 Nutrition, Inflammation, Metabolism

Authors

  • Ye, Xiaoling, Renal Research Institute, New York, New York, United States
  • Raimann, Jochen G., Renal Research Institute, New York, New York, United States
  • Topping, Alice, Renal Research Institute, New York, New York, United States
  • Usvyat, Len A., Fresenius Medical Care North America, Melrose, Massachusetts, United States
  • Kotanko, Peter, Renal Research Institute, New York, New York, United States
  • Kaysen, George A., UC Davis, Davis, California, United States
Background

Reduction in low density lipoprotein (LDL) does not decrease mortality in hemodialysis (HD) patients. The second leading cause of death in HD after cardiovascular (CV) diseases is infectious. LDL absorbs and inactivates bacterial toxins. Injected human LDL prevents endotoxin induced lethality in mice. We examined the effect of LDL, High Density Lipoprotein (HDL) and triglycerides (TG) on infectious, CV events and all cause mortality.

Methods

We explored relationships between blood lipids and outcomes in databases from Renal Research Institute (RRI) clinics in US and Fresenius Medical Care (FMC) clinics in Europe, and west Asia (14,650 patients, 60.2% male). All incident and prevalent patients starting in-center HD between Jan 1, 2000 and Dec 31, 2012 with at least one lipid measurements and inflammatory measures (C reactive protein (CRP)) or neutrophil lymphocyte ratio (NLR) measured were selected. Time to bacterial infectious, CV hospitalization or death or all cause death during up to 4 years of following the last lipid measurement were analyzed by Cox time varying proportional hazards.

Results

LDL reduced risk of infectious death and hospitalizations, and all-cause mortality (HR 0.98 0.971-0.989, (P< 0.001). HDL was associated with a reduction in CV death and hospitilization (HR 0.901 0.847-0.958 P = 0.0009) and all-cause mortality (HR 0.919 0.897-0943 P <0.001) and TG was associated with a reduction in all cause mortality (HR 0.683 0.642-0.726 P <0.001).

Conclusion

Higher LDL is associated with decreased all cause death and infectious death and hospitalizations, but not with increased CV risk, possibly accounting for the observation that reducing LDL cholesterol has a limited effect on outcomes in patients undergoing hemodialysis.

Funding

  • Commercial Support