Hypercholesterolemia Is Not Associated with Arterial Stiffness in Patients with End-Stage Renal Disease-Single Center Experience

Abstract

BACKGROUND: The leading cause of mortality in end-stage renal disease (ESRD) patients is cardiovascular (CV) events and following complications. Although the relation between CV diseases and high mortality in ESRD patients has been well-demonstrated, CV diseases' main contributors have not yet been identified. Some CV risk factors, such as dyslipidemia, were paradoxically associated with better survival in the previous study. In addition, the association between arterial stiffness and dyslipidemia remains uncertain in ESRD patients. An attempt has been made to determine the association between arterial stiffness and total cholesterol in hemodialysis patients in this study. METHODS: This observational, cross-sectional study cohort comprised 217 patients with ESRD on regular hemodialysis in National Taiwan University Hospital Hsin-Chu Branch between 2018. Clinical outcomes were evaluated via brachial-ankle pulse wave velocity (baPWV), which was considered a good indicator of arterial stiffness. We defined arterial stiffness by baPWV level more than 1,800 cm/sec. To assess the association of independent risk factors for arterial stiffness with baPWV value, we divided the patients into the younger subgroup (age ＜ 65 years) and elderly one (age ≥ 65 years), and analyzed with logistic regression analysis with adjustment for multiple variables. RESULTS: We enrolled 217 ESRD patients on regular hemodialysis (mean age, 66.54 years; male, 52.07%; female, 47.92%), and 117 (53.9%) of them presented with baPWV value more than 1,800 cm/ sec. Comparing to the lower baPWV group, the higher baPWV group had greater age (P ＜ 0.001), higher serum ferritin level (P = 0.048), higher cardiothoracic ratio (P ＜ 0.001), and were more likely with comorbidity of diabetes mellitus (P ＜ 0.001). In addition, we found that cholesterol levels appeared higher in the lower baPWV group, regardless of a lack of statistical significance. In multivariate logistic regression analysis, elder age (odds ratio [OR], 1.10; 95% confidence interval [CI] 1.07-1.14; P ＜ 0.001) and diabetes mellitus (OR, 4.07; 95% CI, 2.05-8.00; P ＜ 0.001) were both observed able to predict a higher baPWV value in ESRD patients with regular hemodialysis. In contrast, serum cholesterol level (OR, 1.01; 95% CI, 1.00-1.02; P = 0.074) did not significantly correlate to baPWV in all participants' analysis in our study. CONCLUSIONS: Our study showed that arterial stiffness in ESRD patients was significantly associated with age, chronic inflammation profile such as serum ferritin level, and underlying diseases, including diabetes mellitus. There was no association between hypercholesterolemia and arterial stiffness in our study.