Nonfasting non-high-density lipoprotein cholesterol is adequate for lipid management in hemodialysis patients

Guidelines for the management of dyslipidemia in patients with chronic kidney disease are based on results from the fasting lipid profile, which can be difficult to obtain from patients on an afternoon or night dialysis schedule. The present study tests the hypothesis that nonfasting non-high-density lipoprotein (HDL) cholesterol (total cholesterol-HDL cholesterol) results are similar to fasting non-HDL results as a basis for the management of dyslipidemia in hemodialysis patients.

Forty-eight long-term hemodialysis patients with a mean age of 63.6 years (42% with diabetes, 54% administered statins) participated in this study. For the lipid profile, blood samples were drawn after a 12-hour overnight fast (fasting) and again in a nonfasting state before the subsequent hemodialysis session. Data were analyzed by using paired t-test and regression analysis.

Non-HDL cholesterol values were nearly identical regardless of whether the patient was fasting (r2 = 0.995). Only 2 patients (4%) had a nonfasting triglyceride (TG) level greater than 500 mg/dL (> 5.6 mmol/L), which would have required confirmation after an overnight fast. Non-HDL values had the greatest level of correlation (absolute relative difference, 5.7%). When comparing the subgroup of patients with a TG level less than 200 mg/dL (< 2.3 mmol/L), nonfasting non-HDL cholesterol values identified 3 additional patients compared with fasting calculated low-density lipoprotein cholesterol for whom lipid-lowering therapy would have been introduced according to current guidelines.

In our study, non-HDL cholesterol levels were equivalent whether evaluated in the fasting or nonfasting state. We recommend that nonfasting non-HDL cholesterol level be used for the management of dyslipidemia in hemodialysis patients without imposing a 12-hour fast period.