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Effect of low-density lipoprotein level and mortality in older incident statin-naïve hemodialysis patients

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Abstract
Background
This study aimed to analyze low-density lipoprotein cholesterol (LDL-C) levels and their relationship with mortality in order to identify the appropriate lipid profile for older Korean hemodialysis patients.

Methods
We enrolled a total of 2,732 incident hemodialysis patients aged > 70 years from a retrospective cohort of the Korean Society of Geriatric Nephrology from 2010 Jan to 2017 Dec, which included 17 academic hospitals in South Korea. Of these patients, 1,709 were statin-naïve, and 1,014 were analyzed after excluding those with missing LDL-C level data. We used multivariate Cox regression analysis to select risk factors from 20 clinical variables among the LDL-C groups.

Results
The mean age of the entire patient population was 78 years, with no significant differences in age between quartiles Q1 to Q4. However, the proportion of males decreased as the quartiles progressed towards Q4 (p < 0.001). The multivariate Cox regression analysis, which included all participants, showed that low LDL-C levels were associated with all-cause mortality. In the final model, compared to Q1, the hazard ratios (95% confidence interval) were 0.77 (0.620–0.972; p = 0.027), 0.85 (0.676–1.069; p = 0.166), and 0.65 (0.519–0.824; p < 0.001) for Q2, Q3, and Q4, respectively, after adjusting for covariates, such as conventional and age-specific risk factors. The final model demonstrated that all-cause mortality increased as LDL-C levels decreased, as confirmed by a restrictive cubic spline plot.

Conclusions
In older hemodialysis patients who had not previously received dyslipidemia treatment, elevated LDL-C levels were not associated with increased all-cause mortality. Intriguingly, lower LDL-C levels appear to be associated with an unfavorable effect on all-cause mortality among high-risk hemodialysis patients.
Author(s)
Je Hun SongEun Hee ParkJinsuk BaeSoon Hyo KwonJang-Hee ChoByung Chul YuMiyeun HanSang Heon SongGang-Jee KoJae Won YangSungjin ChungYu Ah HongYoung Youl HyunEunjin BaeIn O. SunHyunsuk KimWon Min HwangSung Joon ShinWoo Yeong ParkHyoungnae KimKyung Don Yoo
Issued Date
2023
Type
Article
Keyword
Low-density lipoproteinsHemodialysisStatinsChronic kidney diseaseAll-cause mortality
DOI
10.1186/s12882-023-03337-5
URI
https://oak.ulsan.ac.kr/handle/2021.oak/17048
Publisher
BMC Nephrology
Language
영어
ISSN
1471-2369
Citation Volume
24
Citation Number
1
Citation Start Page
1
Citation End Page
11
Appears in Collections:
Medicine > Nursing
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