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Peritonitis Affects the Relationship Between Low-Density Lipoprotein Cholesterol and Cardiovascular Events in
Hongjian Ye1, Haishan Wu1, Yuan Peng1
1Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China; Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangzhou, China.
Insights
In peritoneal dialysis (PD), lower low-density lipoprotein cholesterol (LDL-C) increases peritonitis risk. The impact of LDL-C on cardiovascular events and mortality differs based on peritonitis presence.
Area of Science:
- Nephrology
- Cardiology
- Epidemiology
Background:
- The interplay between low-density lipoprotein cholesterol (LDL-C), peritonitis, and cardiovascular (CV) disease in peritoneal dialysis (PD) patients remains unclear.
- Understanding these relationships is crucial for managing CV risk in this vulnerable population.
Purpose of the Study:
- To investigate the associations between baseline LDL-C levels, peritonitis incidence, and major CV events in a large cohort of incident PD patients.
- To explore how peritonitis modifies the relationship between LDL-C and CV outcomes.
Main Methods:
- Retrospective cohort study of 1294 incident PD patients.
- Primary outcome: first major CV event (myocardial infarction, CV death, stroke, arterial revascularization).
- Secondary outcomes: peritonitis, CV mortality, all-cause mortality. Analyzed associations using regression and competing risk models.
Main Results:
- Lower baseline LDL-C quartiles were independently linked to a higher risk of peritonitis.
- No significant association between baseline LDL-C and CV events in the overall cohort.
- Among peritonitis-free patients, increased LDL-C correlated with higher CV risk; conversely, among patients with peritonitis, increased LDL-C correlated with lower CV risk.
- Peritonitis significantly moderated the LDL-C-CV event relationship and influenced LDL-C-mortality associations.
Conclusions:
- Lower baseline LDL-C is associated with increased peritonitis risk in PD patients.
- The effect of LDL-C on cardiovascular events and mortality is significantly modified by the presence or absence of peritonitis.
Background:
In peritoneal dialysis (PD), the relationship among low-density lipoprotein cholesterol (LDL-C), peritonitis, and cardiovascular (CV) disease has not been clarified. This study was performed to explore their associations in a large PD cohort.
Methods:
This retrospective cohort study included incident patients who received PD catheter insertion in our centre. The primary outcome was the first CV event (nonfatal myocardial infarction, CV death, non-haemorrhagic stroke, or any arterial revascularization procedure). Secondary outcomes were the occurrence of peritonitis, CV mortality, and all-cause mortality.
Results:
This study included 1294 patients, whose mean age was 48.1 years. After adjustment for confounders in negative binomial regression models, lower LDL-C quartiles were independently associated with a higher risk of peritonitis, compared with the highest quartile. The multivariate competing risk model showed no significant association between baseline LDL-C and the first CV event in the overall population. However, stratified analysis showed that each 1 mmol/L increase in LDL-C was independently associated with a 21% (subdistribution hazard ratio: 1.21, 95% confidence interval: 1.06-1.39) increased risk of the first CV event among peritonitis-free patients, and with a 20% (subdistribution hazard ratio: 0.80, 95% confidence interval: 0.65-0.99) decreased risk among patients with peritonitis. Moderating-effect analysis showed that the presence of peritonitis significantly influenced the relationships between LDL-C and CV events (P < 0.001). Similar results were also observed in the relationship between LDL-C and mortality.
Conclusions:
PD patients with lower baseline LDL-C had a higher risk of peritonitis. The effect of LDL-C on CV events and mortality was different by the presence of peritonitis events.
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