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Change in Dyslipidemia with Declining Glomerular Filtration Rate and Increasing Proteinuria in Children with CKD.
Clin J Am Soc Nephrol. 2019 12 06; 14(12):1711-1718.CJ

Abstract

BACKGROUND AND OBJECTIVES

Dyslipidemia, a risk factor for cardiovascular disease, is common in CKD but its change over time and how that change is influenced by concurrent progression of CKD have not been previously described.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS

In the CKD in Children study we prospectively followed children with progressive CKD and utilized multivariable, linear mixed-effects models to quantify the longitudinal relationship between within-subject changes in lipid measures (HDL cholesterol, non-HDL cholesterol, triglycerides) and within-subject changes in GFR, proteinuria, and body mass index (BMI).

RESULTS

A total of 508 children (76% nonglomerular CKD, 24% glomerular CKD) had 2-6 lipid measurements each, with a median follow-up time of 4 (interquartile range [IQR], 2.1-6.0) years. Among children with nonglomerular CKD, dyslipidemia was common at baseline (35%) and increased significantly as children aged; 43% of children with glomerular CKD had dyslipidemia at baseline and demonstrated persistent levels as they aged. Longitudinal increases in proteinuria were independently associated with significant concomitant increases in non-HDL cholesterol (nonglomerular: 4.9 [IQR, 3.4-6.4] mg/dl; glomerular: 8.5 [IQR, 6.0-11.1] mg/dl) and triglycerides (nonglomerular: 3% [IQR, 0.8%-6%]; glomerular: 5% [IQR, 0.6%-9%]). Decreases in GFR over follow-up were significantly associated with concomitant decreases of HDL cholesterol in children with nonglomerular CKD (-1.2 mg/dl; IQR, -2.1 to -0.4 mg/dl) and increases of non-HDL cholesterol in children with glomerular CKD (3.9 mg/dl; IQR, 1.4-6.5 mg/dl). The effects of increased BMI also affected multiple lipid changes over time. Collectively, glomerular CKD displayed stronger, deleterious associations between within-subject change in non-HDL cholesterol (9 mg/dl versus 1.2 mg/dl; P<0.001) and triglycerides (14% versus 3%; P=0.004), and within-subject change in BMI; similar but quantitatively smaller differences between the two types of CKD were noted for associations of within-subject change in lipids to within-subject change in GFR and proteinuria.

CONCLUSIONS

Dyslipidemia is a common and persistent complication in children with CKD and it worsens in proportion to declining GFR, worsening proteinuria, and increasing BMI.

Authors+Show Affiliations

Division of Pediatric Nephrology, Icahn School of Medicine at Mount Sinai, New York, New York; Jeffrey.Saland@MSSM.edu.Division of Pediatric Nephrology, Maimonides Medical Center, Brooklyn, New York.Division of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.Department of Pediatrics, University of Washington, Seattle, Washington. Division of Nephrology, Seattle Children's Hospital, Seattle, Washington.Division of Pediatric Nephrology, Cincinnati Children's Hospital, Cincinnati, Ohio.Division of Pediatric Nephrology, Children's Mercy Kansas City, Kansas City, Missouri.Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; and. Division of Nephrology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.

Pub Type(s)

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

Language

eng

PubMed ID

31712386

Citation

Saland, Jeffrey M., et al. "Change in Dyslipidemia With Declining Glomerular Filtration Rate and Increasing Proteinuria in Children With CKD." Clinical Journal of the American Society of Nephrology : CJASN, vol. 14, no. 12, 2019, pp. 1711-1718.
Saland JM, Kupferman JC, Pierce CB, et al. Change in Dyslipidemia with Declining Glomerular Filtration Rate and Increasing Proteinuria in Children with CKD. Clin J Am Soc Nephrol. 2019;14(12):1711-1718.
Saland, J. M., Kupferman, J. C., Pierce, C. B., Flynn, J. T., Mitsnefes, M. M., Warady, B. A., & Furth, S. L. (2019). Change in Dyslipidemia with Declining Glomerular Filtration Rate and Increasing Proteinuria in Children with CKD. Clinical Journal of the American Society of Nephrology : CJASN, 14(12), 1711-1718. https://doi.org/10.2215/CJN.03110319
Saland JM, et al. Change in Dyslipidemia With Declining Glomerular Filtration Rate and Increasing Proteinuria in Children With CKD. Clin J Am Soc Nephrol. 2019 12 6;14(12):1711-1718. PubMed PMID: 31712386.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Change in Dyslipidemia with Declining Glomerular Filtration Rate and Increasing Proteinuria in Children with CKD. AU - Saland,Jeffrey M, AU - Kupferman,Juan C, AU - Pierce,Christopher B, AU - Flynn,Joseph T, AU - Mitsnefes,Mark M, AU - Warady,Bradley A, AU - Furth,Susan L, Y1 - 2019/11/11/ PY - 2019/03/13/received PY - 2019/10/09/accepted PY - 2019/11/13/pubmed PY - 2020/9/23/medline PY - 2019/11/13/entrez KW - HDL cholesterol KW - HDL lipoproteins KW - body mass KW - cardiovascular disease KW - cardiovascular diseases KW - child KW - cholesterol KW - chronic kidney disease KW - chronic renal insufficiency KW - dyslipidemia KW - dyslipidemias KW - follow-up studies KW - glomerular filtration rate KW - humans KW - lipids KW - pediatric nephrology KW - proteinuria KW - risk factors KW - triglycerides SP - 1711 EP - 1718 JF - Clinical journal of the American Society of Nephrology : CJASN JO - Clin J Am Soc Nephrol VL - 14 IS - 12 N2 - BACKGROUND AND OBJECTIVES: Dyslipidemia, a risk factor for cardiovascular disease, is common in CKD but its change over time and how that change is influenced by concurrent progression of CKD have not been previously described. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: In the CKD in Children study we prospectively followed children with progressive CKD and utilized multivariable, linear mixed-effects models to quantify the longitudinal relationship between within-subject changes in lipid measures (HDL cholesterol, non-HDL cholesterol, triglycerides) and within-subject changes in GFR, proteinuria, and body mass index (BMI). RESULTS: A total of 508 children (76% nonglomerular CKD, 24% glomerular CKD) had 2-6 lipid measurements each, with a median follow-up time of 4 (interquartile range [IQR], 2.1-6.0) years. Among children with nonglomerular CKD, dyslipidemia was common at baseline (35%) and increased significantly as children aged; 43% of children with glomerular CKD had dyslipidemia at baseline and demonstrated persistent levels as they aged. Longitudinal increases in proteinuria were independently associated with significant concomitant increases in non-HDL cholesterol (nonglomerular: 4.9 [IQR, 3.4-6.4] mg/dl; glomerular: 8.5 [IQR, 6.0-11.1] mg/dl) and triglycerides (nonglomerular: 3% [IQR, 0.8%-6%]; glomerular: 5% [IQR, 0.6%-9%]). Decreases in GFR over follow-up were significantly associated with concomitant decreases of HDL cholesterol in children with nonglomerular CKD (-1.2 mg/dl; IQR, -2.1 to -0.4 mg/dl) and increases of non-HDL cholesterol in children with glomerular CKD (3.9 mg/dl; IQR, 1.4-6.5 mg/dl). The effects of increased BMI also affected multiple lipid changes over time. Collectively, glomerular CKD displayed stronger, deleterious associations between within-subject change in non-HDL cholesterol (9 mg/dl versus 1.2 mg/dl; P<0.001) and triglycerides (14% versus 3%; P=0.004), and within-subject change in BMI; similar but quantitatively smaller differences between the two types of CKD were noted for associations of within-subject change in lipids to within-subject change in GFR and proteinuria. CONCLUSIONS: Dyslipidemia is a common and persistent complication in children with CKD and it worsens in proportion to declining GFR, worsening proteinuria, and increasing BMI. SN - 1555-905X UR - https://www.unboundmedicine.com/medline/citation/31712386/Change_in_Dyslipidemia_with_Declining_Glomerular_Filtration_Rate_and_Increasing_Proteinuria_in_Children_with_CKD_ DB - PRIME DP - Unbound Medicine ER -