Abstract
Background
In peritoneal dialysis (PD), the relationship among low-density lipoprotein cholesterol
(LDL-C), peritonitis, and cardiovascular (CV) disease has not been clarified. This
study was performed to explore their associations in a large PD cohort.
Methods
This retrospective cohort study included incident patients who received PD catheter
insertion in our centre. The primary outcome was the first CV event (nonfatal myocardial
infarction, CV death, non-haemorrhagic stroke, or any arterial revascularization procedure).
Secondary outcomes were the occurrence of peritonitis, CV mortality, and all-cause
mortality.
Results
This study included 1294 patients, whose mean age was 48.1 years. After adjustment
for confounders in negative binomial regression models, lower LDL-C quartiles were
independently associated with a higher risk of peritonitis, compared with the highest
quartile. The multivariate competing risk model showed no significant association
between baseline LDL-C and the first CV event in the overall population. However,
stratified analysis showed that each 1 mmol/L increase in LDL-C was independently
associated with a 21% (subdistribution hazard ratio: 1.21, 95% confidence interval:
1.06-1.39) increased risk of the first CV event among peritonitis-free patients, and
with a 20% (subdistribution hazard ratio: 0.80, 95% confidence interval: 0.65-0.99)
decreased risk among patients with peritonitis. Moderating-effect analysis showed
that the presence of peritonitis significantly influenced the relationships between
LDL-C and CV events (P < 0.001). Similar results were also observed in the relationship between LDL-C and
mortality.
Conclusions
PD patients with lower baseline LDL-C had a higher risk of peritonitis. The effect
of LDL-C on CV events and mortality was different by the presence of peritonitis events.
Résumé
Contexte
Chez les patients sous dialyse péritonéale (DP), la relation entre le cholestérol
à lipoprotéines de faible densité (C-LDL), la péritonite et la maladie cardiovasculaire
(CV) n’a pas été clairement établie. Cette étude a été menée afin d’explorer les associations
entre ces trois facteurs au sein d’une vaste cohorte de patients sous DP.
Méthodologie
Cette étude de cohorte rétrospective incluait les nouveaux cas d’insertion d’un cathéter
de DP réalisée dans notre établissement. Le paramètre d’évaluation principal était
la première manifestation CV (infarctus du myocarde non mortel, décès d’origine CV,
accident vasculaire cérébral [AVC] non hémorragique ou tout type de revascularisation
artérielle). Les paramètres d’évaluation secondaires étaient la survenue d’une péritonite,
la mortalité d’origine CV et la mortalité toutes causes confondues.
Résultats
Cette étude a été menée auprès de 1 294 patients dont l’âge moyen était de 48,1 ans.
Après correction en fonction des facteurs de confusion dans des modèles de régression
binomiaux négatifs, les quartiles inférieurs du taux de C-LDL étaient associés de
façon indépendante à une augmentation du risque de péritonite, comparativement au
quartile supérieur. Le modèle multivarié à risques concurrents n’a révélé aucune association
significative entre le taux initial de C-LDL et la première manifestation CV dans
l’ensemble de la population. Cependant, l’analyse stratifiée a montré que chaque augmentation
de 1 mmol/l du taux de C-LDL était associée de façon indépendante à une augmentation
de 21 % (rapport de risque de sous-distribution : 1,21; intervalle de confiance [IC]
à 95 % : de 1,06 à 1,39) du risque d’une première manifestation CV chez les patients
non atteints de péritonite, et à une réduction de 20 % (rapport de risque de sous-distribution
: 0,80 : IC à 95 % : de 0,65 à 0,99) de ce même risque chez les patients atteints
de péritonite. L’analyse des effets modérateurs a révélé que la présence d’une péritonite
influençait de façon significative la relation entre le taux de C-LDL et les manifestations
CV (p < 0,001). Des résultats similaires ont été observés pour la relation entre le taux
de C-LDL et la mortalité.
Conclusions
Les patients sous DP dont le taux initial de C-LDL était faible ont présenté un risque
accru de péritonite. L’effet du taux de C-LDL sur les manifestations CV et sur la
mortalité était différent selon qu’il y avait présence ou absence de péritonite.
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Article info
Publication history
Published online: August 29, 2019
Accepted:
August 14,
2019
Received:
June 15,
2019
Footnotes
See editorial by Struijk, pages 22–23 of this issue.
See page 99 for disclosure information.
Identification
Copyright
© 2019 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Failure of Statins to Improve Outcomes in Dialysis Patients: Does Peritonitis Modify the Impact of Lipids on Cardiovascular Events?Canadian Journal of CardiologyVol. 36Issue 1
- PreviewIt is well known that cardiac mortality is exceedingly high in chronic dialysis patients. Because disturbances in plasma lipoprotein metabolism are also frequently observed in dialysis patients, it was assumed that they would benefit from lipid-lowering treatment. And indeed, treatment with statins appeared to be safe and to improve lipid profiles of chronic dialysis patients.1,2 However, 3 large randomized placebo-controlled trials failed to show a reduction in cardiovascular mortality in dialysis patients.
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