Inverse association between lipid levels and mortality in men with chronic kidney disease who are not yet on dialysis: Effects of case mix and the malnutrition-inflammation-cachexia syndrome
Inverse association between lipid levels and mortality in men with chronic kidney disease who are not yet on dialysis: Effects of case mix and the malnutrition-inflammation-cachexia syndrome
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DOI：
10.1681/asn.2006060674
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发表时间：
2007-01-01
影响因子：
13.6
通讯作者：
Kalantar-Zadeh, Kamyar
中科院分区：
文献类型：
--
作者：
Kovesdy, Csaba P.;Anderson, John E.;Kalantar-Zadeh, Kamyar
在透析患者中，高总胆固醇与较低的死亡率相关，但在患有慢性肾脏疾病(CKD)且尚未进行透析的患者中，血脂水平与死亡率之间的关系尚未得到很好的描述。这项研究调查了986名患有慢性肾脏病且尚未接受透析的男性患者(年龄67.4+/-10.9岁，23.7%为黑人)的血脂水平与全因和心血管死亡率之间的关系。在对营养不良-炎症-恶病质综合征(MICS)的病例组合和替代物进行调整前后，在固定协变量和时间依赖的COX模型中确定相关性。在根据年龄、种族和体重指数调整的固定协变量模型中，较低的总胆固醇四分位数与较高的全因死亡率相关(胆固醇153、153至182和183至215的危险比[95%可信区间]与215 mg/dl：1.91[1.35至2.69]、1.36[0.96至1.92]、1.10[0.78至1.57]；P<；趋势为0.001)，但在对病例组合进行调整(趋势为P=0.023)后，这种关联减弱，而在对MICS进行额外调整后(趋势为P=0.14)，这种关联被取消，时间依赖的COX模型显示出类似的结果。在固定协变量和时间依赖分析中，在低密度脂蛋白水平与总死亡率和心血管死亡率以及甘油三酯与全因死亡率之间的关联中也发现了类似的趋势。在中晚期CKD患者中，血脂水平较低的患者死亡率较高，且尚未进行透析。这种反向关联的部分原因是病例混合的特征和MICs代用品的存在。
High total cholesterol is associated with lower mortality in dialysis patients, but the relationship between lipid levels and mortality in patients who have chronic kidney disease (CKD) and are not yet on dialysis is poorly described. This study examined the association between lipid levels and all-cause and cardiovascular mortality in 986 male patients (age 67.4 +/- 10.9 yr; race 23.7% black) who had CKD and were not yet on dialysis. Associations were determined in fixed-covariate and time-dependent Cox models, before and after adjustment for components of case mix and surrogates for malnutrition-inflammation-cachexia syndrome (MICS). Lower total cholesterol quartiles were associated with higher all-cause mortality in a fixed-covariate model that was adjusted for age, race, and body mass index (hazard ratio [95% confidence interval] for cholesterol < 153, 153 to 182, and 183 to 215 versus > 215 mg/dl: 1.91 [1.35 to 2.69], 1.36 [0.96 to 1.92], 1.10 [0.78 to 1.57]; P < 0.001 for trend), but this association was attenuated after adjustment for case mix (P = 0.023 for trend) and abolished after additional adjustment for MICS (P = 0.14 for trend), with time-dependent Cox models showing similar results. Similar tendencies also were detected in the association between levels of LDL cholesterol with total and cardiovascular mortality and triglycerides with all-cause mortality in both fixed-covariate and time-dependent analyses. Lower lipid levels are associated with higher mortality in patients who have moderate and advanced CKD and are not yet on dialysis. This inverse association is explained in part by case-mix characteristics and the presence of surrogates for MICS.