In:
Clinical Journal of the American Society of Nephrology, Ovid Technologies (Wolters Kluwer Health), Vol. 8, No. 11 ( 2013-11), p. 1915-1926
Abstract:
Malnutrition and/or inflammation may modify the risk relationship of total cholesterol with cardiovascular disease in CKD patients. However, it is unclear whether the relationship of total cholesterol with cardiovascular events and mortality varies by proteinuria. Design, setting, participants, & measurements This study enrolled 3303 patients with CKD stages 3–5 from a medical center and a regional hospital between November of 2002 and May of 2009 and followed the patients until July of 2010. Results During a median 2.8-year follow-up, there were 471 (14.3%) deaths and 545 (16.5%) cardiovascular events. In an adjusted Cox model, the two highest quartiles of total cholesterol (hazard ratio, 1.90; 95% confidence interval, 1.16 to 3.13 and hazard ratio, 2.00; 95% confidence interval, 1.18 to 3.39 versus quartile 1, respectively) were associated with a significant higher risk of all-cause mortality in patients with urine protein-to-creatinine ratio 〈 1 g/g ( n =1535), but this higher risk was not seen in those patients with urine protein-to-creatinine ratio≥1 g/g ( n =1768; hazard ratio, 0.75; 95% confidence interval, 0.53 to 1.07 and hazard ratio, 0.70; 95% confidence interval, 0.49 to 1.02 versus quartile 1, respectively). The interaction between total cholesterol and proteinuria with all-cause mortality was significant (interaction, P =0.05). However, the relationship between total cholesterol and cardiovascular events did not significantly differ by proteinuria (interaction, P =0.91). Conclusions The association between cholesterol and mortality is different among patients with different levels of proteinuria. Large-scale clinical trials to evaluate the mortality benefit should specifically target lowering hypercholesterolemia in CKD patients with different levels of proteinuria.
Type of Medium:
Online Resource
ISSN:
1555-9041
DOI:
10.2215/CJN.02350213
Language:
English
Publisher:
Ovid Technologies (Wolters Kluwer Health)
Publication Date:
2013
detail.hit.zdb_id:
2216582-4
Permalink