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Canadian Journal of Cardiology

Peritonitis Affects the Relationship Between Low-Density Lipoprotein Cholesterol and Cardiovascular Events in Peritoneal Dialysis Patients

  • Author Footnotes
    ‡ These authors contributed equally to this work.
    Hongjian Ye
    Footnotes
    ‡ These authors contributed equally to this work.
    Affiliations
    Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China

    Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangzhou, China
    Search for articles by this author
  • Author Footnotes
    ‡ These authors contributed equally to this work.
    Haishan Wu
    Footnotes
    ‡ These authors contributed equally to this work.
    Affiliations
    Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China

    Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangzhou, China
    Search for articles by this author
  • Yuan Peng
    Affiliations
    Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China

    Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangzhou, China
    Search for articles by this author
  • Qian Zhou
    Affiliations
    Department of Medical Statistics, Clinical Trials Unit, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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  • Peiyi Cao
    Affiliations
    Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China

    Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangzhou, China
    Search for articles by this author
  • Qunying Guo
    Affiliations
    Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China

    Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangzhou, China
    Search for articles by this author
  • Haiping Mao
    Affiliations
    Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China

    Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangzhou, China
    Search for articles by this author
  • Xueqing Yu
    Affiliations
    Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China

    Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangzhou, China
    Search for articles by this author
  • Xiao Yang
    Correspondence
    Correspondent author: Dr Xiao Yang, Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China. Tel.: +86-20-87755766-8843; fax: +86-20-87769673.
    Affiliations
    Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China

    Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangzhou, China
    Search for articles by this author
  • Author Footnotes
    ‡ These authors contributed equally to this work.
Published:August 29, 2019DOI:https://doi.org/10.1016/j.cjca.2019.08.028

      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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