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논문분류	춘계학술대회 초록집
제목	Association of Serum Lipid Levels over Time with Survival in Incident Peritoneal dialysis Patients
저자	Cheol ho PARK1, Ea wha KANG2, Jung tak PARK1, Seung hyeok HAN1, Taehyun YOO1, Shin-wook KANG1, *Tae ik CHANG2
출판정보	2017; 2017(1):
키워드	Lipid, Survival, Peritoneal dialysis
초록	Objectives : Paradoxical associations between serum lipid levels and mortality have been frequently observed in hemodialysis patients. However, the association of dyslipidemia with mortality has not been fully evaluated in patients on peritoneal dialysis (PD). Moreover, change in lipids levels over time and associated death risk have not yet been studied in this population. Methods : We studied the association between time-updated serum lipid concentrations and all-cause and cardiovascular (CV) mortality in a 10-year cohort of 739 incident PD patients during 1/1/2006-12/31/2015, using timevarying Cox proportional hazard regression models. Results : During a median follow-up of 36 (inter-quartile range, 21-61) months, 273 all-cause and 107 CV deaths occurred. Compared to those with timevarying total cholesterol (TC) of 180 to <210 or low-density lipoprotein cholesterol (LDL-C) of 100 to <130 mg/dL, the hazard ratios (95% confidence intervals) of the lowest TC (<150 mg/dL) and LDL-C (<70 mg/dL) were 2.32 (1.61-3.35) and 2.02 (1.45-2.83) for all-cause mortality and 1.87 (1.04-3.37) and 1.92 (1.13-3.26) for CV mortality, respectively. In addition, lower triglyceride (<100 mg/dL) and HDL-C (<30 mg/dL) levels were associated with higher all-cause mortality (1.66 [1.11-2.47] and 1.57 [1.08-2.29]), but not CV mortality. Conclusions : Contrary to the general population, lower TC and LDL-C levels over time were significantly associated with both worse survival and increased CV mortality in incident PD patients. Similarly, lower time-updated triglyceride and HDL-C concentrations were also associated with higher all-cause mortality, but they did not have any clear associations with CV mortality. Further studies are needed to explain the underlying mechanisms responsible for these paradoxical associations between lower lipid levels (i.e., TC, LDL-C, and triglyceride) and poor outcomes in patient population with end-stage renal disease.
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