Clinical and Experimental Nephrology

, Volume 16, Issue 5, pp 767–772 | Cite as

Serum non-high-density lipoprotein cholesterol (non-HDL-C) levels and cardiovascular mortality in chronic hemodialysis patients

  • Yoshihisa Echida
  • Tetsuya Ogawa
  • Kuniaki Otsuka
  • Yoshitaka Ando
  • Kosaku Nitta
Original Article
First Online:
Received:
Accepted:

Abstract

Background

Non-high-density lipoprotein cholesterol (non-HDL-C) has been proposed as a predictor of cardiovascular disease (CVD) in the general population. The aim of this study was to evaluate the utility of non-HDL-C in predicting CV mortality in chronic hemodialysis (HD) patients.

Methods

We calculated the serum non-HDL-C level of 259 HD patients by subtracting their HDL-C levels from their total cholesterol. Cox proportional hazards models were used to estimate the hazards ratio (HR) for CV mortality and the 95% confidence interval (CI). A receiver-operating characteristic (ROC) analysis was performed to estimate the relationship between sensitivity and specificity of a diagnostic parameter.

Results

There were 44 deaths (17.0%) during the follow-up period, 33 (12.7%) of which were due to CVD. A multivariate Cox analysis with adjustments for age, diabetes, dialysis vintage, systolic blood pressure, serum albumin, and lipid levels showed that non-HDL-C was an independent predictor of CV mortality (HR 1.015, 95% CI 1.004–1.025, p = 0.0083). An ROC analysis showed that the plots of the non-HDL-C levels yielded significant specificity and sensitivity for predicting the risk of CVD mortality in HD patients [area under the curve (AUC) 0.62416; p = 0.0366; cutoff value 111.0 mg/dl]. The Kaplan–Meier survival curves of HD patients showed significant differences in CV mortality according to their tertiles with respect to serum non-HDL-C levels (p = 0.0165).

Conclusion

The results of this study suggest that serum non-HDL-C level is a significant CV mortality predictor of chronic HD patients.

Keywords:

Cardiovascular disease Dyslipidemia Non-HDL cholesterol Mortality Hemodialysis 
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Notes

Acknowledgments

This work was in part supported by a grant of the Japan Promotion Society of Cardiovascular disease.

Conflict of interest

None.

References

  1. 1.
    Nakai S, Suzuki K, Masakane I, Wada A, Itami N, Ogata S, et al. An overview of regular dialysis treatment in Japan (as of 31 December 2007). Ther Apher Dial. 2010;14:505–40.PubMedCrossRefGoogle Scholar
  2. 2.
    Kaysen GA. Lipid and lipoprotein metabolism in chronic kidney disease. J Ren Nutr. 2009;19:73–7.PubMedCrossRefGoogle Scholar
  3. 3.
    National Kidney Foundation. K/DOQI clinical practice guidelines for managing dyslipidemia in chronic kidney disease. Am J Kidney Dis. 2003;39:S1–91.Google Scholar
  4. 4.
    Grundy SM. Non-high-density lipoprotein cholesterol level as potential risk predictor and therapy target. Arch Intern Med. 2001;161:1379–80.PubMedCrossRefGoogle Scholar
  5. 5.
    Cui Y, Blumenthal RS, Flaws JA, Whiteman MK, Langenberg P, Bachorik PS, et al. Non-high-density lipoprotein cholesterol level as a predictor of cardiovascular disease mortality. Arch Intern Med. 2001;161:1413–9.PubMedCrossRefGoogle Scholar
  6. 6.
    Desmeules S, Arcand-Bosse JF, Bergeron J, Douville P, Aqharazii M. Nonfasting non-high-density lipoprotein cholesterol is adequate for lipid management in hemodialysis patients. Am J Kidney Dis. 2005;45:1067–72.PubMedCrossRefGoogle Scholar
  7. 7.
    Friedewald WT, Levy RI, Fredrickson DS. Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem. 1972;18:499–502.PubMedGoogle Scholar
  8. 8.
    Alberti KG, Zimmet PZ. Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabet Med. 1998;15:539–53.PubMedCrossRefGoogle Scholar
  9. 9.
    Liu J, Sempos CT, Donahue RP, Dorn J, Trevisan M, Grundy SM. Non-high-density lipoprotein and very-low-density lipoprotein cholesterol and their risk predictive values in coronary heart disease. Am J Cardiol. 2006;98:1363–8.PubMedCrossRefGoogle Scholar
  10. 10.
    Okamura T, Kokubo Y, Watanabe M, Higashiyama A, Miyamoto Y, Yoshimasa Y, et al. Low-density lipoprotein cholesterol and non-high-density lipoprotein cholesterol and the incidence of cardiovascular disease in an urban Japanese cohort study: the Suita study. Atherosclerosis. 2009;203:587–92.PubMedCrossRefGoogle Scholar
  11. 11.
    Kitamura A, Noda H, Nakamura H, Kiyama M, Okada T, Imano H, et al. Association between non-high-density lipoprotein cholesterol levels and the incidence of coronary heart disease among Japanese: the Circulatory Risk in Communities Study (CIRCS). J Atheroscler Thromb. 2011;18:454–63.PubMedCrossRefGoogle Scholar
  12. 12.
    Nishizawa T, Shoji T, Kakiya R, Tsujimoto Y, Tabata T, Ishimura E, et al. Non-high-density lipoprotein cholesterol (non-HDL-C) as a predictor of cardiovascular mortality in patients with end-stage renal disease. Kidney Int. 2003;63(Suppl. 84):S117–20.CrossRefGoogle Scholar
  13. 13.
    Shoji T, Masakane I, Watanabe Y, Iseki K. Committee of Renal data Registry, Japanese Society for Dialysis Therapy. Elevated non-high-density lipoprotein cholesterol (non-HDL-C) predicts atherosclerotic cardiovascular events in hemodialysis patients. Clin J Am Soc Nephrol. 2011;6:1112–20.PubMedCrossRefGoogle Scholar
  14. 14.
    Schreier L, Gonzalez AI, Elbert A, Berg G, Wikibski R. Utility of non-high-density lipoprotein cholesterol in hemodialyzed patients. Metabolism. 2004;53:1013–5.PubMedCrossRefGoogle Scholar
  15. 15.
    Desmeules S, Arcand-Bosse JF, Bergeron J, Douville P, Aqharazii M. Nonfasting non-high-density lipoprotein cholesterol is adequate for lipid management in hemodialysis patients. Am J Kidney Dis. 2005;45:1067–72.PubMedCrossRefGoogle Scholar
  16. 16.
    Wanner C, Krane V. Non-high-density lipoprotein cholesterol: a target of lipid-lowering in dialysis patients. Am J Kidney Dis. 2003;41(3 Suppl 1):S72–5.PubMedCrossRefGoogle Scholar
  17. 17.
    Seliger SL, Weiss NS, Gillen DL, Kestenbaum B, Ball A, Sherrard DJ, et al. HMG-CoA reductase inhibitors are associated with reduced mortality in ESRD patients. Kidney Int. 2002;61:297–304.PubMedCrossRefGoogle Scholar
  18. 18.
    Mason NA, Bailie GR, Satayathum S, Bragg-Gresham JL, Akiba T, Akizawa T, et al. HMG-coenzyme a reductase inhibitor use is associated with mortality reduction in hemodialysis patients. Am J Kidney Dis. 2005;45:119–26.PubMedCrossRefGoogle Scholar
  19. 19.
    Goldfarb-Rumyantzev AS, Habib AN, Baird BC, Barenbaum LL, Cheung AK. The association of lipid-modifying medications with mortality in patients on long-term peritoneal dialysis. Am J Kidney Dis. 2007;50:791–802.PubMedCrossRefGoogle Scholar
  20. 20.
    Wanner C, Krane V, Marz W, Olschewski M, Asmus HG, Kramer W, et al. Randomized controlled trial on the efficacy and safety of atorvastatin in patients with type 2 diabetes on hemodialysis (4D study): demographic and baseline characteristics. Kidney Blood Press Res. 2004;27:259–66.PubMedCrossRefGoogle Scholar
  21. 21.
    Wanner C, Krane V, Marz W, Olschewski M, Mann JF, Ruf G, et al. Atorvastatin in patients with type 2 diabetes mellitus undergoing hemodialysis. N Engl J Med. 2005;353:238–48.PubMedCrossRefGoogle Scholar
  22. 22.
    Shoji T, Nishizawa Y. Plasma lipoprotein abnormalities in hemodialysis patients—clinical implications and therapeutic guidelines. Ther Apher Dial. 2006;10:305–15.PubMedCrossRefGoogle Scholar
  23. 23.
    Ritz E, Wanner C. Lipid changes and statins in chronic renal insufficiency. J Am Soc Nephrol. 2006;17:S226–30.PubMedCrossRefGoogle Scholar
  24. 24.
    Kaysen GA, Dubin JA, Muller HG, Mitch WE, Rosales LM, Levin NW. Relationships among inflammation nutrition and physiologic mechanisms establishing albumin levels in hemodialysis patients. Kidney Int. 2002;61:2240–9.PubMedCrossRefGoogle Scholar

Copyright information

© Japanese Society of Nephrology 2012

Authors and Affiliations

  • Yoshihisa Echida
    • 1
  • Tetsuya Ogawa
    • 2
  • Kuniaki Otsuka
    • 2
  • Yoshitaka Ando
    • 3
  • Kosaku Nitta
    • 1
  1. 1.Department of Medicine, Kidney CenterTokyo Women’s Medical UniversityTokyoJapan
  2. 2.Department of Medicine, Medical Center EastTokyo Women’s Medical UniversityTokyoJapan
  3. 3.Hidaka HospitalTakasakiJapan

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