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

• Published in: BMC nephrology 2023-10, Vol.24 (1), p.1-289, Article 289
• Main Authors: Song, Je Hun, Park, Eun Hee, Bae, Jinsuk, Kwon, Soon Hyo, Cho, Jang-Hee, Yu, Byung Chul, Han, Miyeun, Song, Sang Heon, Ko, Gang-Jee, Yang, Jae Won, Chung, Sungjin, Hong, Yu Ah, Hyun, Young Youl, Bae, Eunjin, Sun, In O, Kim, Hyunsuk, Hwang, Won Min, Shin, Sung Joon, Park, Woo Yeong, Kim, Hyoungnae, Yoo, Kyung Don
• Format: Article
• Language: English
• Subjects: Age; All-cause mortality; Analysis; Anticholesteremic agents; Atherosclerosis; Blood lipids; Body mass index; Cardiovascular disease; Care and treatment; Cholesterol; Cholesterol, LDL; Chronic kidney disease; Chronic kidney failure; Clinical medicine; Clinical practice guidelines; Dosage and administration; Dyslipidemia; Health aspects; Heart failure; Hemodialysis; Hemodialysis patients; Hemoglobin; High density lipoprotein; Hospitals; Hypertension; Ischemia; Kidney diseases; Lipoproteins; Liver cirrhosis; Low density lipoprotein; Low density lipoproteins; Measurement; Medical research; Medicine, Experimental; Metabolic disorders; Mortality; Nephrology; Older people; Patient outcomes; Patients; Peritoneal dialysis; Prevention; Regression analysis; Risk factors; Software; South Korea; Statins; Triglycerides
• ISSN: 1471-2369; 1471-2369
• DOI: 10.1186/s12882-023-03337-5

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. Keywords: Low-density lipoproteins, Hemodialysis, Statins, Chronic kidney disease, All-cause mortality