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Abstract: PO2035

Association of Low-Density Lipoprotein Cholesterol with Time to ESRD Across CKD Stages in 2 Million US Veterans

Session Information

Category: Health Maintenance, Nutrition, and Metabolism

  • 1300 Health Maintenance, Nutrition, and Metabolism

Authors

  • Hsiung, Jui-Ting, VA Long Beach Healthcare System, Long Beach, California, United States
  • Marroquin, Maria V., VA Long Beach Healthcare System, Long Beach, California, United States
  • Soohoo, Melissa, VA Long Beach Healthcare System, Long Beach, California, United States
  • Kovesdy, Csaba P., Memphis VA Medical Center, Memphis, Tennessee, United States
  • Kalantar-Zadeh, Kamyar, Harold Simmons Center, UC Irvine, Orange, California, United States
  • Streja, Elani, VA Long Beach Healthcare System, Long Beach, California, United States
Background

Prior studies have noted that abnormal triglyceride (TG) and high-density lipoprotein cholesterol (HDL) are predictors for chronic kidney disease (CKD) outcomes. However, it remains unclear whether similar patterns are observed for low-density lipoprotein cholesterol (LDL). Therefore, we sought to investigate the relationship of LDL with time to end-stage renal disease (ESRD) risk across CKD stages.

Methods

The cohort comprised 1,961,854 US veterans with a serum LDL between 2004-2006 and were not on ESRD. Patients were followed until ESRD, death, loss to follow up or Dec 2014, whichever occured first. We used a Cox model to examine the association of LDL and time to ESRD stratified by baseline CKD stages. The model adjustment include demographics, comorbid conditions, smoking status, prescription of statins and non-statins, body mass index, albumin, HDL, and TG.

Results

Patients were an average age of 64±14 years, and included 5% females, 14% African- Americans, 19% diabetics, 32% statin-users, and 44% current smokers. The median [IQR] of serum LDL level and eGFR at baseline were 103[81,128] mg/dL and 75[60,91] mL/min/1.73m2, respectively. Higher LDL (>100 mg/dL) was associated with incrementally higher ESRD risk across all CKD stages compared to the reference (LDL 70-<100 mg/dL). Notably, LDL≥ 160 mg/dL were associated with the highest risks of ESRD, and this association gradually diminished across progressive CKD stages. Low LDL (<70 mg/dL) was associated with null risk of ESRD across all CKD stages.

Conclusion

Higher serum LDL was associated with higher risk of ESRD across all CKD stage in the US veterans. However the strength of this relationship attenuated with worsening CKD. Future studies with considerations for competing death events, time varying covariates and the impact of lipid modifying therapies are warranted.

Funding

  • Veterans Affairs Support