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Relation of serum lipids and lipoproteins with progression of CKD: The CRIC study.

Abstract

BACKGROUND AND OBJECTIVES

Hyperlipidemia is common in patients with CKD. The objective of this study was to evaluate whether measures of plasma lipids and lipoproteins predict progression of kidney disease in patients with CKD.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS

Prospective cohort study in adults (n=3939) with CKD aged 21-74 years recruited between 2003 and 2008 and followed for a median of 4.1 years. At baseline, total cholesterol, triglycerides, very-low-density lipoprotein cholesterol (VLDL-C), LDL cholesterol (LDL-C), HDL cholesterol (HDL-C), apoA-I , apoB, and lipoprotein(a) [Lp(a)] were measured. The outcomes were composite end point of ESRD or 50% decline in eGFR from baseline (rate of change of GFR).

RESULTS

Mean age of the study population was 58.2 years, and the mean GFR was 44.9 ml/min per 1.73 m(2); 48% of patients had diabetes. None of the lipid or lipoprotein measures was independently associated with risk of the composite end point or rate of change in GFR. However, there were significant (P=0.01) interactions by level of proteinuria. In participants with proteinuria<0.2 g/d, 1-SD higher LDL-C was associated with a 26% lower risk of the renal end point (hazard ratio [HR], 0.74; 95% confidence interval [95% CI], 0.59 to 0.92; P=0.01), and 1-SD higher total cholesterol was associated with a 23% lower risk of the renal end point (HR, 0.77; 95% CI, 0.62 to 0.96; P=0.02). In participants with proteinuria>0.2 g/d, neither LDL-C (HR, 0.98; 95% CI, 0.98 to 1.05) nor total cholesterol levels were associated with renal outcomes. Treatment with statins was reported in 55% of patients and was differential across lipid categories.

CONCLUSIONS

In this large cohort of patients with CKD, total cholesterol, triglycerides, VLDL-C, LDL-C, HDL-C, apoA-I, apoB, and Lp(a) were not independently associated with progression of kidney disease. There was an inverse relationship between LDL-C and total cholesterol levels and kidney disease outcomes in patients with low levels of proteinuria.

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  • Authors+Show Affiliations

    ,

    Department of Medicine, Case Western Reserve University, University Hospitals Case Medical Center, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio; Mahboob.Rahman@uhhospitals.org.

    ,

    Center for Clinical Epidemiology and Biostatistics and.

    ,

    Division of Nephrology, University of Illinois, Chicago, Illinois;

    ,

    Department of Epidemiology, Tulane University, New Orleans, Louisiana;

    ,

    Center for Clinical Epidemiology and Biostatistics and.

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    Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland;

    ,

    Department of Epidemiology, Tulane University, New Orleans, Louisiana;

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    Division of Nephrology, George Washington University, Washington, DC;

    ,

    Case Western Reserve University, MetroHealth Medical Center, Cleveland, Ohio; and.

    ,

    University Hospitals Case Medical Center, Cleveland, Ohio.

    ,

    Center for Clinical Epidemiology and Biostatistics and.

    ,

    Division of Translational Medicine and Human Genetics, University of Pennsylvania, Philadelphia, Pennsylvania;

    Source

    MeSH

    Adult
    Aged
    Biological Markers
    Disease Progression
    Female
    Glomerular Filtration Rate
    Humans
    Hydroxymethylglutaryl-CoA Reductase Inhibitors
    Hyperlipidemias
    Kidney
    Kidney Failure, Chronic
    Lipids
    Lipoproteins
    Male
    Middle Aged
    Prospective Studies
    Protective Factors
    Proteinuria
    Renal Insufficiency, Chronic
    Risk Factors
    Young Adult

    Pub Type(s)

    Journal Article
    Observational Study
    Research Support, N.I.H., Extramural

    Language

    eng

    PubMed ID

    24832097

    Citation

    TY - JOUR T1 - Relation of serum lipids and lipoproteins with progression of CKD: The CRIC study. AU - Rahman,Mahboob, AU - Yang,Wei, AU - Akkina,Sanjeev, AU - Alper,Arnold, AU - Anderson,Amanda Hyre, AU - Appel,Lawrence J, AU - He,Jiang, AU - Raj,Dominic S, AU - Schelling,Jeffrey, AU - Strauss,Louise, AU - Teal,Valerie, AU - Rader,Daniel J, AU - ,, Y1 - 2014/05/15/ PY - 2014/5/15/aheadofprint PY - 2014/5/17/entrez PY - 2014/5/17/pubmed PY - 2015/4/7/medline PY - 2015/7/7/pmc-release KW - chronic kidney disease KW - lipids KW - progression of chronic renal failure SP - 1190 EP - 8 JF - Clinical journal of the American Society of Nephrology : CJASN JO - Clin J Am Soc Nephrol VL - 9 IS - 7 N2 - BACKGROUND AND OBJECTIVES: Hyperlipidemia is common in patients with CKD. The objective of this study was to evaluate whether measures of plasma lipids and lipoproteins predict progression of kidney disease in patients with CKD. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Prospective cohort study in adults (n=3939) with CKD aged 21-74 years recruited between 2003 and 2008 and followed for a median of 4.1 years. At baseline, total cholesterol, triglycerides, very-low-density lipoprotein cholesterol (VLDL-C), LDL cholesterol (LDL-C), HDL cholesterol (HDL-C), apoA-I , apoB, and lipoprotein(a) [Lp(a)] were measured. The outcomes were composite end point of ESRD or 50% decline in eGFR from baseline (rate of change of GFR). RESULTS: Mean age of the study population was 58.2 years, and the mean GFR was 44.9 ml/min per 1.73 m(2); 48% of patients had diabetes. None of the lipid or lipoprotein measures was independently associated with risk of the composite end point or rate of change in GFR. However, there were significant (P=0.01) interactions by level of proteinuria. In participants with proteinuria<0.2 g/d, 1-SD higher LDL-C was associated with a 26% lower risk of the renal end point (hazard ratio [HR], 0.74; 95% confidence interval [95% CI], 0.59 to 0.92; P=0.01), and 1-SD higher total cholesterol was associated with a 23% lower risk of the renal end point (HR, 0.77; 95% CI, 0.62 to 0.96; P=0.02). In participants with proteinuria>0.2 g/d, neither LDL-C (HR, 0.98; 95% CI, 0.98 to 1.05) nor total cholesterol levels were associated with renal outcomes. Treatment with statins was reported in 55% of patients and was differential across lipid categories. CONCLUSIONS: In this large cohort of patients with CKD, total cholesterol, triglycerides, VLDL-C, LDL-C, HDL-C, apoA-I, apoB, and Lp(a) were not independently associated with progression of kidney disease. There was an inverse relationship between LDL-C and total cholesterol levels and kidney disease outcomes in patients with low levels of proteinuria. SN - 1555-905X UR - https://www.unboundmedicine.com/medline/citation/24832097/full_citation L2 - http://cjasn.asnjournals.org/cgi/pmidlookup?view=long&amp;pmid=24832097 ER -