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Published on: July 19, 2018
Hyperlipidemia and mortality in patients on peritoneal dialysis
Xiaoran Feng1, Xiaojiang Zhan2, Yueqiang Wen3
1Department of Nephrology, Jiujiang No. 1 People's Hospital, Jiujiang, China.
Insights
Hyperlipidemia in continuous ambulatory peritoneal dialysis (CAPD) patients is linked to increased long-term mortality, especially when hypertension is present. Long-term lipid-lowering therapy is recommended for these individuals.
Area of Science:
- Nephrology
- Cardiovascular Medicine
- Metabolic Disorders
Background:
- Current guidelines do not recommend initiating lipid-lowering therapy in dialysis patients.
- This approach may be inappropriate given the potential impact of hyperlipidemia on patient outcomes.
Purpose of the Study:
- To investigate the association between hyperlipidemia and all-cause mortality in patients undergoing continuous ambulatory peritoneal dialysis (CAPD).
- To explore the potential modifying role of hypertension in this relationship.
Main Methods:
- A retrospective cohort study included 2939 incident CAPD patients from 2005 to 2018.
- Cox proportional hazards regression was used to analyze the association between hyperlipidemia at CAPD initiation and all-cause mortality.
Main Results:
- Hyperlipidemia was present in 18.1% of patients; 17.7% died during follow-up.
- While no increased mortality risk was seen initially, hyperlipidemia was associated with a 2.26-fold higher mortality risk after 48 months.
- Hypertension significantly modified this association, with a 2.27-fold increased mortality risk observed in hypertensive patients with hyperlipidemia.
Conclusions:
- Hyperlipidemia at CAPD initiation is associated with a high risk of long-term mortality.
- Hypertension appears to mediate this association, highlighting the need for careful management.
- Long-term lipid-lowering treatment should be considered for CAPD patients with hyperlipidemia.
Background:
New lipid-lowering therapy at the start of dialysis and measurement of lipid parameters over the follow-up period is not recommended in dialysis patients, which seems unappropriated in clinical practice. We aimed to examine the effect of hyperlipidemia on mortality in patients undergoing continuous ambulatory peritoneal dialysis (CAPD).
Methods:
A retrospective cohort study was performed, including 2939 incident CAPD patients from five dialysis facilities between January 1, 2005, and December 31, 2018. The primary outcome was all-cause mortality. The association between hyperlipidemia at the start of CAPD and all-cause mortality was evaluated using Cox proportional hazards regression.
Results:
Of 2939 with a median age of 50.0 (interquartile range, 39.0-61.0), 1697 (57.7%) were men, 533 (18.1%) had hyperlipidemia, 549 (18.7%) had diabetes mellitus, 1915 (65.2%) had hypertension, and 410 (14.0%) had a history of CVD. During the median follow-up period of 35.1 months, 519 (17.7%) died, including 402 (16.7%, 47.4/1000 patient-years) in the non-hyperlipidemia group and 117 (22.0%, 71.1/1000 patient-years) in the hyperlipidemia group. Over the overall follow-up period, patients with hyperlipidemia had an equally high risk of all-cause mortality throughout follow-up as those without hyperlipidemia ([HR] 1.04, 95% confidence interval [CI] 0.83 to 1.31). However, from the 48-month follow-up onwards, hyperlipidemia was associated with a 2.26 (95% CI 1.49 to 3.43)-time higher risk of all-cause mortality than non-hyperlipidemia. Hypertension modified the association between hyperlipidemia and all-cause mortality (P for interaction < 0.001). A significantly increased risk of all-cause mortality was observed among patients with hypertension (HR 2.27, 95%CI 1.44-3.58).
Conclusion:
Among CAPD patients, hyperlipidemia at the beginning of CAPD was associated with a high risk of long-term mortality. Hypertension may mediate the association. Our findings suggested that long-term lipid-lowering treatment should be used in those patients with hyperlipidemia.
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