| Titre : | Association between cholesterol level and mortality in dialysis patients : Role of inflammation and malnutrition. (2004) |
| Auteurs : | . YONGMEI LIU ; Josef CORESH ; Joseph-A EUSTACE ; Nancy-E FINK ; Bernard JAAR ; Michael-J KLAG ; LONGENECKER (Jcraig) : KWT. Kuwait University. ; Neil-R POWE ; TRACY (Russell-P) : USA. University of Vermont. Burlington. ; Johns Hopkins University. Baltimore Md. KWT |
| Type de document : | Article |
| Dans : | JAMA - Journal of the american medical association (vol. 291, n° 4, 2004) |
| Pagination : | 451-459 |
| Langues: | Anglais |
| Mots-clés : | Malnutrition ; Association ; Cholestérol ; Mortalité ; Epidémiologie ; Hémodialyse ; Homme ; Inflammation ; Surveillance ; Facteur risque ; Lipide ; Maladie nutrition ; Appareil épuration extrarénale |
| Résumé : | [BDSP. Notice produite par INIST-CNRS K1R0x1Tx. Diffusion soumise à autorisation]. Context : Total cholesterol level is inversely associated with mortality in dialysis patients, a group at high risk of cardiovascular disease (CVD). This paradox may be explained by systemic inflammation and/or malnutrition, which are associated with lower cholesterol levels and higher mortality. Objective : To determine the relationship between cholesterol level and outcome in patients undergoing dialysis, accounting for inflammation and malnutrition. Design, Setting, and Participants : Prospective study of 823 patients enrolled from October 1995 to June 1998 who recently initiated dialysis, from 79 clinics, classified by absence or presence of inflammation and/or malnutrition (defined as serum albumin levels<3.6 mg/dL, C-reactive protein>=10 mg/L, or interleukin 6>=3.09 pg/mL). Main Outcome Measures : All-cause and cardiovascular disease mortality. Results During a median follow-up of 2.4 years, 324 deaths (159 CVD deaths), 153 renal transplantations, and 10 losses to follow-up occurred. Average serum cholesterol level was lower in the presence of inflammation/malnutrition than in its absence. In a Cox model adjusted for age, race, and sex, a 40-mg/dL (1.0-mmol/L) increment in baseline total serum cholesterol level was associated with a decreased risk of all-cause mortality overall (relative hazard [RH], 0.92 ; 95% confidence interval [CI], 0.87-0.98) and in the presence of inflammation/malnutrition (RH, 0.89 ; CI, 0.84-0.95). In contrast, serum cholesterol level was associated with an increased risk in the absence of inflammation/malnutrition (RH, 1.32 ; 95% CI, 1.07-1.63). For CVD mortality, an inverse trend was not statistically significant in the presence of inflammation/malnutrition, and a positive association was evident in the absence of inflammation/malnutrition (RH, 1.41 ; 95% Cl, 1.04-1.89). Further adjustment for traditional CVD risk factors, dialysis modality, comorbidity, and inflammatory markers attenuated the inverse association but strengthened the positive association. Conclusions : The inverse association of total cholesterol level with mortality in dialysis patients is likely due to the cholesterol-lowering effect of systemic inflammation and malnutrition, not to a protective effect of high cholesterol concentrations. These findings support treatment of hypercholesterolemia in this population. |
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