Associations of lipoproteins with cardiovascular and infection-related outcomes in patients receiving hemodialysis

George Kaysen, Barbara Grimes, Lorien Dalrymple, Glenn M. Chertow, Julie H. Ishida, Cynthia Delgado, Mark Segal, Janet Chiang, Tjien Dwyer, Kirsten L. Johansen

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background: In hemodialysis (HD) patients, higher lipid levels are associated with lower mortality. Lipid-lowering therapy does not reduce all-cause mortality or cardiovascular (CV) mortality. Lipoproteins play a role in the innate immune system. Our objective was to determine whether protection from infection might counterbalance adverse CV outcomes associated with lipoproteins. Methods: We examined associations between serum apolipoprotein (Apo) A1, B, C2, C3, high-density lipoprotein and low-density lipoprotein (LDL) cholesterol and triglyceride levels and infectious mortality or hospitalization, CV mortality or hospitalization, and all-cause mortality in 433 prevalent HD patients. Cox models with time-varying apolipoprotein concentrations collected every 6 months for up to 2 years were used for analyses. Results: Median follow-up time for all-cause mortality was 2.7 years (25th–75th percentile range: 2.2–3.4 years). One hundred seventy-nine (41%) patients had an infection-related event. In multivariable models, higher Apo B and LDL were associated with lower risks of infection-related outcomes (hazard ratio Apo B 0.92 [95% confidence interval 0.86–0.99 per 10 mg/dL, P =.03]; hazard ratio LDL 0.93 [95% confidence interval 0.87–1.00 per 10 mg/dL, P =.05]). Sixty-three (15%) participants had a CV-related event. No significant associations were observed between lipoproteins and CV outcomes. Eighty-seven (20%) participants died. Higher Apo A1, Apo B, and Apo C3 were associated with lower risks of all-cause mortality. There was no interaction between the use of lipid-lowering medication and any of the outcomes. Conclusion: Associations of lipoproteins with lower risk of serious infection accompanied by no significant association with CV events may help to explain the paradoxical association between lipids and survival and lack of benefit of lipid-lowering therapies in HD.

Original languageEnglish (US)
Pages (from-to)481-487.e14
JournalJournal of Clinical Lipidology
Volume12
Issue number2
DOIs
StatePublished - Mar 1 2018

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Cardiovascular Infections
Lipoproteins
Renal Dialysis
Mortality
Apolipoproteins B
Lipids
Apolipoproteins
Apolipoprotein A-I
Infection
LDL Lipoproteins
Hospitalization
Confidence Intervals
HDL Lipoproteins
Proportional Hazards Models
LDL Cholesterol
Immune System

Keywords

  • ACTIVE/ADIPOSE
  • Apolipoprotein B
  • Apolipoprotein C2
  • Cardiovascular
  • Infection
  • LDL
  • Lipoproteins
  • USRDS

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Nutrition and Dietetics
  • Cardiology and Cardiovascular Medicine

Cite this

Associations of lipoproteins with cardiovascular and infection-related outcomes in patients receiving hemodialysis. / Kaysen, George; Grimes, Barbara; Dalrymple, Lorien; Chertow, Glenn M.; Ishida, Julie H.; Delgado, Cynthia; Segal, Mark; Chiang, Janet; Dwyer, Tjien; Johansen, Kirsten L.

In: Journal of Clinical Lipidology, Vol. 12, No. 2, 01.03.2018, p. 481-487.e14.

Research output: Contribution to journalArticle

Kaysen, G, Grimes, B, Dalrymple, L, Chertow, GM, Ishida, JH, Delgado, C, Segal, M, Chiang, J, Dwyer, T & Johansen, KL 2018, 'Associations of lipoproteins with cardiovascular and infection-related outcomes in patients receiving hemodialysis', Journal of Clinical Lipidology, vol. 12, no. 2, pp. 481-487.e14. https://doi.org/10.1016/j.jacl.2017.12.007
Kaysen, George ; Grimes, Barbara ; Dalrymple, Lorien ; Chertow, Glenn M. ; Ishida, Julie H. ; Delgado, Cynthia ; Segal, Mark ; Chiang, Janet ; Dwyer, Tjien ; Johansen, Kirsten L. / Associations of lipoproteins with cardiovascular and infection-related outcomes in patients receiving hemodialysis. In: Journal of Clinical Lipidology. 2018 ; Vol. 12, No. 2. pp. 481-487.e14.
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abstract = "Background: In hemodialysis (HD) patients, higher lipid levels are associated with lower mortality. Lipid-lowering therapy does not reduce all-cause mortality or cardiovascular (CV) mortality. Lipoproteins play a role in the innate immune system. Our objective was to determine whether protection from infection might counterbalance adverse CV outcomes associated with lipoproteins. Methods: We examined associations between serum apolipoprotein (Apo) A1, B, C2, C3, high-density lipoprotein and low-density lipoprotein (LDL) cholesterol and triglyceride levels and infectious mortality or hospitalization, CV mortality or hospitalization, and all-cause mortality in 433 prevalent HD patients. Cox models with time-varying apolipoprotein concentrations collected every 6 months for up to 2 years were used for analyses. Results: Median follow-up time for all-cause mortality was 2.7 years (25th–75th percentile range: 2.2–3.4 years). One hundred seventy-nine (41{\%}) patients had an infection-related event. In multivariable models, higher Apo B and LDL were associated with lower risks of infection-related outcomes (hazard ratio Apo B 0.92 [95{\%} confidence interval 0.86–0.99 per 10 mg/dL, P =.03]; hazard ratio LDL 0.93 [95{\%} confidence interval 0.87–1.00 per 10 mg/dL, P =.05]). Sixty-three (15{\%}) participants had a CV-related event. No significant associations were observed between lipoproteins and CV outcomes. Eighty-seven (20{\%}) participants died. Higher Apo A1, Apo B, and Apo C3 were associated with lower risks of all-cause mortality. There was no interaction between the use of lipid-lowering medication and any of the outcomes. Conclusion: Associations of lipoproteins with lower risk of serious infection accompanied by no significant association with CV events may help to explain the paradoxical association between lipids and survival and lack of benefit of lipid-lowering therapies in HD.",
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AU - Grimes, Barbara

AU - Dalrymple, Lorien

AU - Chertow, Glenn M.

AU - Ishida, Julie H.

AU - Delgado, Cynthia

AU - Segal, Mark

AU - Chiang, Janet

AU - Dwyer, Tjien

AU - Johansen, Kirsten L.

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