Serum non-high-density lipoprotein cholesterol (non-HDL-C) levels and cardiovascular mortality in chronic hemodialysis patients

• Published in: Clinical and experimental nephrology Vol. 16; no. 5; pp. 767 - 772
• Main Authors: Echida, Yoshihisa, Ogawa, Tetsuya, Otsuka, Kuniaki, Ando, Yoshitaka, Nitta, Kosaku
• Format: Journal Article
• Language: English
• Published: Japan Springer Japan 01.10.2012; Springer Nature B.V
• Subjects: Aged; Cardiovascular Diseases - mortality; Cholesterol - blood; Cholesterol, HDL - blood; Cohort Studies; Female; Humans; Japan - epidemiology; Kaplan-Meier Estimate; Kidney Failure, Chronic - mortality; Male; Medicine; Medicine & Public Health; Middle Aged; Nephrology; Original Article; Proportional Hazards Models; Prospective Studies; Renal Dialysis - mortality; Risk Assessment; ROC Curve; Urology; Japan; Cardiovascular disease; Non-HDL cholesterol; Hemodialysis; Mortality; Dyslipidemia
• ISSN: 1342-1751; 1437-7799
• DOI: 10.1007/s10157-012-0615-5

Background Non-high-density lipoprotein cholesterol (non-HDL-C) has been proposed as a predictor of cardiovascular disease (CVD) in the general population. The aim of this study was to evaluate the utility of non-HDL-C in predicting CV mortality in chronic hemodialysis (HD) patients. Methods We calculated the serum non-HDL-C level of 259 HD patients by subtracting their HDL-C levels from their total cholesterol. Cox proportional hazards models were used to estimate the hazards ratio (HR) for CV mortality and the 95% confidence interval (CI). A receiver-operating characteristic (ROC) analysis was performed to estimate the relationship between sensitivity and specificity of a diagnostic parameter. Results There were 44 deaths (17.0%) during the follow-up period, 33 (12.7%) of which were due to CVD. A multivariate Cox analysis with adjustments for age, diabetes, dialysis vintage, systolic blood pressure, serum albumin, and lipid levels showed that non-HDL-C was an independent predictor of CV mortality (HR 1.015, 95% CI 1.004–1.025, p  = 0.0083). An ROC analysis showed that the plots of the non-HDL-C levels yielded significant specificity and sensitivity for predicting the risk of CVD mortality in HD patients [area under the curve (AUC) 0.62416; p  = 0.0366; cutoff value 111.0 mg/dl]. The Kaplan–Meier survival curves of HD patients showed significant differences in CV mortality according to their tertiles with respect to serum non-HDL-C levels ( p  = 0.0165). Conclusion The results of this study suggest that serum non-HDL-C level is a significant CV mortality predictor of chronic HD patients.