Kidney Week

Abstract: TH-PO413

HDL Cholesterol Level and Its Impact on Cardiovascular Mortality in Peritoneal Dialysis Patients

Session Information

• Dialysis: Peritoneal Dialysis - I
  October 25, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

• 703 Dialysis: Peritoneal Dialysis

Authors

• Lee, Yong kyu, Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California, Irvine, Orange, California, United States

Yong kyu Lee,

• Streja, Elani, Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California, Irvine, Orange, California, United States

Elani Streja,

• Kalantar-Zadeh, Kamyar, Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California, Irvine, Orange, California, United States

Kamyar Kalantar-Zadeh,

• Moradi, Hamid, Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California, Irvine, Orange, California, United States

Hamid Moradi,

Background

HDL cholesterol is traditionally believed to be beneficial in preventing cardiovascular mortality by reverse cholesterol transport and restricting LDL cholesterol oxidation. However, in ESRD patients, the effect of HDL cholesterol was shown to deviate due to its qualitative and quantitative alteration.

Methods

7,839 peritoneal dialysis (PD) patients were selected from a national cohort of patients treated at a large dialysis organization during 2007~2011. We sought to verify the relationship between HDL cholesterol and total cholesterol/HDL cholesterol ratio and all-cause mortality. Each exposure parameter was divided into 6 strata and 3 different hierarchical adjustment models were applied to observe the change in relationship after adjustment.

Results

Although patients with low HDL cholesterol showed higher all-cause mortality risk in the unadjusted model, the risk was attenuated after adjustment, with a hazard ratio of 1.235 (0.970-1.573) in the case-mix adjusted model. However, patients with low total cholesterol/HDL ratio showed higher all-cause mortality risk which was robust even after adjustment for case-mix and markers of malnutrition/inflammation (MICS), with a hazard ratio of 1.433 (1.183-1.736) in the case-mix adjusted model. Both showed a reversed J-shaped association with the inflection point at 50-60mg/dL for HDL cholesterol and 4-5 for total cholesterol:HDL cholesterol ratio. The highest HDL cholesterol level group showed a mortality risk of 1.090 (0.836-1.421) and the highest total cholesterol:HDL cholesterol ratio group showed a mortality risk of 1.178 (0.940-1.477).

Conclusion

PD patients with low HDL cholesterol and total cholesterol:HDL cholesterol ratio showed higher all-cause mortality. However, higher HDL cholesterol and total cholesterol:HDL cholesterol ratios showed neither the beneficial effect observed in the general population nor the deleterious effect observed in HD patients.

Funding

• NIDDK Support