Association between the triglyceride to high-density lipoprotein cholesterol ratio and mortality in Chinese maintenance haemodialysis patients: a retrospective cohort study

Abstract

Objective: To investigate the relationship between the triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) ratio and all-cause and cardiovascular (CV) mortality in Chinese haemodialysis (HD) patients.

Design: Retrospective cohort study.

Setting: Patients from June 2015 to September 2016 and followed through September 2021 were categorised into quartiles according to the follow-up averaged TG/HDL-C ratio. The association between TG/HDL-C and mortality was examined by univariate and multivariate time-varying Cox regression analyses. The C-index was used to assess the predictive accuracy of the Cox regression models.

Participants: A total of 534 maintenance HD patients were enrolled.

Primary and secondary outcome measures: The outcomes were all-cause death and CV mortality.

Results: During the median follow-up of 61 months, 207 patients died, with 94 (45.4%) classified as CV death. After adjusting for confounders, multivariate time-varying Cox regression analysis showed that the quartile 4 group (TG/HDL-C ≥2.64) was associated with decreased all-cause mortality (adjusted HR 0.51, 95% CI 0.33-0.77, p=0.001) and CV mortality (adjusted HR 0.31; 95% CI 0.16 to 0.62; p=0.001) in maintenance HD patients. Model 1 of all-cause mortality achieved a C-index of 0.72 (95% CI 0.68 to 0.75), and model 2 achieved a C-index of 0.77 (95% CI 0.73 to 0.82). The C-index for model 1 in CV mortality was 0.74 (95% CI 0.70 to 0.77), and the C-index for model 2 was 0.80 (95% CI 0.75 to 0.84).

Conclusions: High TG/HDL-C was associated with decreased all-cause and CV mortality in HD patients.

Keywords: Chronic Disease; Dialysis; End stage renal failure; Lipid disorders; Nephrology.

Figure 1

A high TG/HDL-C ratio was associated with decreased mortality in HD patients. (A) Time-varying all-cause mortality HR (comparison of 95% CI differences); model 1: adjusted for age, dialysis vintage, cause of ESRD, hypertension, CVD and diabetes; model 2: adjusted for model 1 covariates and laboratory parameters including Hb, Ca and Alb. (B) Time-varying cardiovascular mortality HR (comparison of 95% CI differences); model 1: adjusted for age, dialysis vintage, cause of ESRD, hypertension, CVD and diabetes; model 2: adjusted for model 1 covariates and laboratory parameters including PTH, Ca, P and Alb. Alb, albumin; BMI, Body Mass Index; CVD, cardiovascular disease; ESRD, end-stage renal disease; Hb, haemoglobin; HD, haemodialysis; HDL-C, high-density lipoprotein cholesterol; PTH, parathyroid hormone; TG, triglyceride.