Abstract
Increasing evidence suggests that lipid variability may be a predictor of cardiovascular events. However, few studies have evaluated the association between lipid variability and renal outcomes in patients with moderate-to-advanced chronic kidney disease (CKD). Therefore, the aims of this study were to assess whether lipid variability is associated with progression to dialysis in patients with CKD stage 3–5, and to evaluate the risk factors of lipid variability. This longitudinal study enrolled 725 patients with CKD stage 3–5. Intra-individual lipid variability was defined as the standard deviations (SDs) of lipid levels. The renal end-point was defined as commencing dialysis. During a mean follow-up period of 3.2 years, 208 patients (28.7%) started dialysis. The patients with CKD stage 3 with high low-density lipoprotein (LDL) cholesterol SD (per 1 mg/dL; hazard ratio, 1.035; 95% confidence interval, 1.003 to 1.067; p = 0.003) were associated with an increased risk of progression to dialysis, however this association was not seen in the patients with CKD stage 4 or 5. Furthermore, in the patients with CKD stage 3, a high urine protein-to-creatinine ratio (p < 0.001) and the use of statins (p < 0.001) were significantly associated with an increased LDL-cholesterol SD. Greater LDL-cholesterol variability was associated with an increased risk of progression to dialysis in patients with CKD stage 3, but not in those with CKD stage 4 or 5. These findings support the potential role of aggressive lipid control on clinical outcomes and highlight its importance in patients with CKD stage 3.
Highlights
Chronic kidney disease (CKD) severely impairs key enzymes and metabolic pathways, leading to the dysregulation of high-density lipoprotein (HDL) cholesterol and triglyceride-rich lipoproteins [1]
Compared to patients who did not progress to dialysis, those who did progress to dialysis were younger, had a higher prevalence of coronary artery disease, higher urine protein-to-creatinine ratio (UPCR), more advanced CKD stage, lower levels of albumin, baseline estimated glomerular filtration rate, hemoglobin, and total calcium, higher levels of phosphorous and uric acid, and higher standard deviation (SD) levels of triglycerides, total cholesterol, HDL-cholesterol and low-density lipoprotein (LDL)-cholesterol
For CKD stage 4, compared to patients who did not progress to dialysis, those who did progress to dialysis were younger, male predominant, diabetes, lower albumin, lower hemoglobin, lower baseline estimated glomerular filtration rate (eGFR), lower total calcium, higher phosphorous, higher SD LDL-cholesterol, higher UPCR, and higher percentage of calcium channel blockers and diuretics use
Summary
Chronic kidney disease (CKD) severely impairs key enzymes and metabolic pathways, leading to the dysregulation of high-density lipoprotein (HDL) cholesterol and triglyceride-rich lipoproteins [1]. Previous studies on lipid profiles have reported hypertriglyceridemia, hypercholesterolemia, higher levels of low-density lipoprotein (LDL) cholesterol, and lower levels of HDL-cholesterol in patients with CKD [2, 3]. The progression of CKD can worsen these metabolic derangements, potentially leading to atherogenic diathesis www.impactjournals.com/oncotarget and a further decline in renal function. Clinical studies on the association between the use of statins and progression of renal disease in patients with mild-to-moderate kidney failure have reported inconsistent findings, some have suggested that statin therapy can decrease the rate of decline in renal function [9,10,11]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
