LIPIDS AND CARDIOVASCULAR OUTCOME IN THE DIALYSIS POPULATION

摘要

The prevalence of cardiovascular disease in the dialysis population is much greater than in the generaL population, and dyslipidemia represents a possible risk factor and a potential target for therapy. While the purpose of this commentis not intended to be an extensive review of the subject, some important points need to be mentioned.While the prevalence of both cardiovascular disease (1) and dyslipidemia (2,3) in the dialysis population is greater than in the generaL population, the association between lipid leveland clinical outcome is controversial. Several epidemiologic studies have shown that serum total choLesterol Levels below 200 mg/dL (5.17 mmol/L) are paradoxically associated with increased mortality in patients on hemodialysis (4-6) and peritoneal dialysis (PD) (7). True causal association, thatis, the case where uremia and/or the diaLysis procedure alters the effect of cholesterolonclinicaLoutcome, may potentially explain this phenomenon. Alternatively, the phenomenon might be the result of statistical confounding by other factors [e.g., malnutrition/inflammation that can potentially affect both Lipid levels and mortality (4-6,8)] or late-life and reverse-causality biases that are described in medicaL Literature (8,9). Interestingly, in the absence of hypoalbuminemia or inflammation (the latter based on interleukin-6 level.), the association between total cho-lesteroLLeveland mortality in diaLysis patients was shown to be similar to that in the general population (8). On the other hand, in our study of PD patients based on retrospective USRDS data analysis, hypoalbuminemia did not seem to play a significant role in the relationship between total choLesterol and mortality (7).