Effects of Cholesterol Levels on Mortality in Patients with Long-Term Peritoneal Dialysis Based on Residual Renal Function

Abstract

The effect of dyslipidemia on peritoneal dialysis (PD) patients based on the presence of residual renal function (RRF; renal creatinine clearance >2 mL/min/1.73 m2) is unknown. Data from the Taiwan Renal Registry Data System between 2005 and 2012 were analyzed to estimate the association between dyslipidemia and mortality in PD patients. Long-term PD patients (n = 8032) were divided into groups with (RRF; n = 2691, 33.5%) and without RRF (non-RRF; n = 5341, 66.5%). The primary outcome was three-year mortality, and multivariate Cox regression was used for survival analysis. After stratifying the total cholesterol (TC) level between the first and third years, the hazard ratio for mortality was estimated. In the non-RRF group, TC < 120 mg/dL was associated with independently increased risk of mortality. In the RRF group, low TC was not independently correlated with increased mortality, but TC > 285 mg/dL was associated with increased risk. PD patients with higher level of TC (>200 mg/dL) in both first and third years of dialysis had significantly lower risk of mortality. In this nationwide cohort study, PD patients without RRF who had low TC level had the highest mortality, in contrast to those with RRF. Malnutrition in long-term PD patients without RRF is an important issue to be monitored.

Association between Dyslipidemia and Peritoneal Dialysis Technique Survival

“…They also showed an association between a decrease in HDL and deterioration of RRF [20]. LinYC et al analysed the data from a nationwide population-based cohort study and concluded that the effect of lipid profiles on mortality was modified by RRF [30]. In the present study, we did not analyse RRF in the patients.…”

“…Association between dyslipidemia and mortality in PD patients has been well characterized [12], [23], [24], [25]. However, there have been no reports on the association between pro-atherogenic lipid profiles and PD technique survival.…”

“…Moreover, we observed a significant decrease in residual diuresis in dyslipidemia conditions. Additionally, fluid and weight control problems are common amongst PD patients and may be accompanied by dyslipidemia [16], [20], [25], [29], [31]. Rincón et al found the mean increase in fat mass of 3.0 ± 3.2 kg/year during the 26-month-follow-up period.…”

Aberrant serum parathyroid hormone, calcium, and phosphorus as risk factors for peritonitis in peritoneal dialysis patients

“…In Taiwan, the National Health Insurance (NHI) provides universal health care and covers more than 99% of the Taiwanese population. To comply with the government reimbursement system and the Taiwan Society of Nephrology (TSN) accreditation of dialysis therapy (including PD and HD), all dialysis units are obliged to provide a predefined set of patient-specific health information and laboratory data through a web-based electronic database, and from that the Taiwan Renal Registry Data System (TWRDS) has been established and comprises a nationwide cohort of ESRD patients receiving kidney replacement therapy 21 , 22 .…”

Serum alkaline phosphatase levels correlate with long-term mortality solely in peritoneal dialysis patients with residual renal function

“…Patients were categorized according to their RRF status (presence vs. absence). The presence of RRF was defined as having a creatinine clearance of >2 mL/min/1.73 m 2 , according to a prior study [14]. The serum ALP levels were divided into tertiles: RRF group: T1 < 67 U/L, T2 67–92 U/L, and T3 ≥ 92 U/L; non-RRF group, T1 < 60 U/L, T2 60–85 U/L, and T3 ≥ 85 U/L.…”