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Review
. 2015 Feb 4;5(1):19-29.
doi: 10.1159/000371410. eCollection 2015 Jan-Apr.

Lipid levels and renal function decline in pre-dialysis patients

Moniek C M de Goeij  1 , Joris I Rotmans  2 , Xanthe Matthijssen  1 , Dinanda J de Jager  1 , Friedo W Dekker  1 , Nynke Halbesma  3 ; PREPARE-2 Study Group
Affiliations
Review

Lipid levels and renal function decline in pre-dialysis patients

Moniek C M de Goeij et al. Nephron Extra. .

Abstract

Background: Little is known about the effect of low-density lipoprotein (LDL) cholesterol, triglyceride (TG), and high-density lipoprotein (HDL) cholesterol levels on renal function decline in patients receiving specialized pre-dialysis care.

Methods: In the prospective PREPARE-2 study, incident patients starting pre-dialysis care were included when referred to one of the 25 participating Dutch specialized pre-dialysis outpatient clinics (2004-2011). Clinical and laboratory data were collected every 6 months. A linear mixed model was used to compare renal function decline between patients with LDL cholesterol, TG, or HDL cholesterol levels above and below the target goals (LDL cholesterol: <2.50 mmol/l, TG: <2.25 mmol/l, and HDL cholesterol: ≥1.00 mmol/l). Additionally the HDL/LDL cholesterol ratio was investigated (≥0.4).

Results: In our study population (n = 306), the median age was 69 years and 70% were male. Patients with LDL cholesterol levels above the target of 2.50 mmol/l experienced an accelerated renal function decline compared to patients with levels below the target (crude additional decline: 0.10 ml/min/1.73 m(2)/month, 95% CI 0.00-0.20; p < 0.05). A similar trend was found for TG levels above the target of 2.25 mmol/l (0.05 ml/min/1.73 m(2)/month, 95% CI -0.06 to 0.16) and for a HDL/LDL cholesterol ratio below 0.4 (0.06 ml/min/1.73 m(2)/month, 95% CI -0.05 to 0.18). Adjustment for potential confounders resulted in similar results, and the exclusion of patients who were prescribed lipid-lowering medication (statin, fibrate, or cholesterol absorption inhibitor) resulted in a slightly larger estimated effect.

Conclusion: High levels of LDL cholesterol were associated with an accelerated renal function decline, independent of the prescription of lipid-lowering medication.

Keywords: CKD stages IV–V; Fibrate; Lipids; Pre-dialysis care; Renal function decline; Statin.

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Figures

Fig. 1
Fig. 1
Association of lipid levels with renal function decline. The lines represent the crude renal function decline for patients achieving and those not achieving the recommended target goal for LDL cholesterol levels (a), TG levels (b), HDL cholesterol levels (c), and the HDL/LDL cholesterol ratio (d). These intercepts and slopes were estimated with a linear mixed model.
See this image and copyright information in PMC

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