Increments in serum high-density lipoprotein cholesterol over time are not associated with improved outcomes in incident hemodialysis patients

Tae Ik Chang, Elani Streja, Melissa Soohoo, Gang Jee Ko, Connie M. Rhee, Csaba P. Kovesdy, Moti L. Kashyap, Nosratola D. Vaziri, Kamyar Kalantar-Zadeh, Hamid Moradi

Research output: Contribution to journalArticle

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Abstract

Background: Elevated serum high-density lipoprotein cholesterol (HDL-C) has not been associated with better cardiovascular (CV) and all-cause mortality in hemodialysis patients. However, the association between change in HDL over time and mortality has not been fully examined. Objective: In a nationally representative cohort of incident hemodialysis patients who had available HDL data at baseline and 6 months after dialysis initiation, we studied the association of change in HDL-C during the first 6 months of dialysis with all-cause and CV mortality. Methods: Associations between HDL-C change and mortality were determined in Cox proportional hazard regression models with adjustment for multiple variables. Results: In case-mix models, there was a J-shaped association between change in HDL-C and mortality, such that quartiles 1 (<-5 mg/dL) and 4 (≥7 mg/dL) were each associated with higher all-cause (hazard ratio, 1.32 [95% confidence interval, 1.21-1.45] and 1.09 [1.01-1.18]) and CV (1.28 [1.06-1.55] and 1.23 [1.04-1.45]) death risk, respectively. In fully adjusted models that included indices of malnutrition and inflammation, the higher death risk observed in the lowest quartile was attenuated, whereas the highest quartile continued to demonstrate significantly higher all-cause (1.11 [1.02-1.20]) and CV mortality (1.15 [1.00-1.32]). These associations persisted across various subgroups. Conclusions: Although malnutrition and inflammation may explain the increased risk for mortality in patients with decreasing serum HDL-C concentrations over time, these indices do not mitigate the elevated risk in patients with rising serum HDL-C. We found that increasing serum HDL-C over time is paradoxically associated with worse outcomes in incident hemodialysis patients.

Original languageEnglish
JournalJournal of Clinical Lipidology
DOIs
Publication statusAccepted/In press - 2018 Jan 1

Fingerprint

HDL Cholesterol
Renal Dialysis
Mortality
Serum
Malnutrition
Dialysis
Inflammation
Diagnosis-Related Groups
Proportional Hazards Models
Confidence Intervals

Keywords

  • Dyslipidemia
  • Hemodialysis
  • High-density lipoprotein
  • Lipid
  • Mortality

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Nutrition and Dietetics
  • Cardiology and Cardiovascular Medicine

Cite this

Increments in serum high-density lipoprotein cholesterol over time are not associated with improved outcomes in incident hemodialysis patients. / Chang, Tae Ik; Streja, Elani; Soohoo, Melissa; Ko, Gang Jee; Rhee, Connie M.; Kovesdy, Csaba P.; Kashyap, Moti L.; Vaziri, Nosratola D.; Kalantar-Zadeh, Kamyar; Moradi, Hamid.

In: Journal of Clinical Lipidology, 01.01.2018.

Research output: Contribution to journalArticle

Chang, Tae Ik ; Streja, Elani ; Soohoo, Melissa ; Ko, Gang Jee ; Rhee, Connie M. ; Kovesdy, Csaba P. ; Kashyap, Moti L. ; Vaziri, Nosratola D. ; Kalantar-Zadeh, Kamyar ; Moradi, Hamid. / Increments in serum high-density lipoprotein cholesterol over time are not associated with improved outcomes in incident hemodialysis patients. In: Journal of Clinical Lipidology. 2018.
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abstract = "Background: Elevated serum high-density lipoprotein cholesterol (HDL-C) has not been associated with better cardiovascular (CV) and all-cause mortality in hemodialysis patients. However, the association between change in HDL over time and mortality has not been fully examined. Objective: In a nationally representative cohort of incident hemodialysis patients who had available HDL data at baseline and 6 months after dialysis initiation, we studied the association of change in HDL-C during the first 6 months of dialysis with all-cause and CV mortality. Methods: Associations between HDL-C change and mortality were determined in Cox proportional hazard regression models with adjustment for multiple variables. Results: In case-mix models, there was a J-shaped association between change in HDL-C and mortality, such that quartiles 1 (<-5 mg/dL) and 4 (≥7 mg/dL) were each associated with higher all-cause (hazard ratio, 1.32 [95{\%} confidence interval, 1.21-1.45] and 1.09 [1.01-1.18]) and CV (1.28 [1.06-1.55] and 1.23 [1.04-1.45]) death risk, respectively. In fully adjusted models that included indices of malnutrition and inflammation, the higher death risk observed in the lowest quartile was attenuated, whereas the highest quartile continued to demonstrate significantly higher all-cause (1.11 [1.02-1.20]) and CV mortality (1.15 [1.00-1.32]). These associations persisted across various subgroups. Conclusions: Although malnutrition and inflammation may explain the increased risk for mortality in patients with decreasing serum HDL-C concentrations over time, these indices do not mitigate the elevated risk in patients with rising serum HDL-C. We found that increasing serum HDL-C over time is paradoxically associated with worse outcomes in incident hemodialysis patients.",
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T1 - Increments in serum high-density lipoprotein cholesterol over time are not associated with improved outcomes in incident hemodialysis patients

AU - Chang, Tae Ik

AU - Streja, Elani

AU - Soohoo, Melissa

AU - Ko, Gang Jee

AU - Rhee, Connie M.

AU - Kovesdy, Csaba P.

AU - Kashyap, Moti L.

AU - Vaziri, Nosratola D.

AU - Kalantar-Zadeh, Kamyar

AU - Moradi, Hamid

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Background: Elevated serum high-density lipoprotein cholesterol (HDL-C) has not been associated with better cardiovascular (CV) and all-cause mortality in hemodialysis patients. However, the association between change in HDL over time and mortality has not been fully examined. Objective: In a nationally representative cohort of incident hemodialysis patients who had available HDL data at baseline and 6 months after dialysis initiation, we studied the association of change in HDL-C during the first 6 months of dialysis with all-cause and CV mortality. Methods: Associations between HDL-C change and mortality were determined in Cox proportional hazard regression models with adjustment for multiple variables. Results: In case-mix models, there was a J-shaped association between change in HDL-C and mortality, such that quartiles 1 (<-5 mg/dL) and 4 (≥7 mg/dL) were each associated with higher all-cause (hazard ratio, 1.32 [95% confidence interval, 1.21-1.45] and 1.09 [1.01-1.18]) and CV (1.28 [1.06-1.55] and 1.23 [1.04-1.45]) death risk, respectively. In fully adjusted models that included indices of malnutrition and inflammation, the higher death risk observed in the lowest quartile was attenuated, whereas the highest quartile continued to demonstrate significantly higher all-cause (1.11 [1.02-1.20]) and CV mortality (1.15 [1.00-1.32]). These associations persisted across various subgroups. Conclusions: Although malnutrition and inflammation may explain the increased risk for mortality in patients with decreasing serum HDL-C concentrations over time, these indices do not mitigate the elevated risk in patients with rising serum HDL-C. We found that increasing serum HDL-C over time is paradoxically associated with worse outcomes in incident hemodialysis patients.

AB - Background: Elevated serum high-density lipoprotein cholesterol (HDL-C) has not been associated with better cardiovascular (CV) and all-cause mortality in hemodialysis patients. However, the association between change in HDL over time and mortality has not been fully examined. Objective: In a nationally representative cohort of incident hemodialysis patients who had available HDL data at baseline and 6 months after dialysis initiation, we studied the association of change in HDL-C during the first 6 months of dialysis with all-cause and CV mortality. Methods: Associations between HDL-C change and mortality were determined in Cox proportional hazard regression models with adjustment for multiple variables. Results: In case-mix models, there was a J-shaped association between change in HDL-C and mortality, such that quartiles 1 (<-5 mg/dL) and 4 (≥7 mg/dL) were each associated with higher all-cause (hazard ratio, 1.32 [95% confidence interval, 1.21-1.45] and 1.09 [1.01-1.18]) and CV (1.28 [1.06-1.55] and 1.23 [1.04-1.45]) death risk, respectively. In fully adjusted models that included indices of malnutrition and inflammation, the higher death risk observed in the lowest quartile was attenuated, whereas the highest quartile continued to demonstrate significantly higher all-cause (1.11 [1.02-1.20]) and CV mortality (1.15 [1.00-1.32]). These associations persisted across various subgroups. Conclusions: Although malnutrition and inflammation may explain the increased risk for mortality in patients with decreasing serum HDL-C concentrations over time, these indices do not mitigate the elevated risk in patients with rising serum HDL-C. We found that increasing serum HDL-C over time is paradoxically associated with worse outcomes in incident hemodialysis patients.

KW - Dyslipidemia

KW - Hemodialysis

KW - High-density lipoprotein

KW - Lipid

KW - Mortality

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