title: Hypocholesterolemia is a significant predictor of death in a cohort of chronic hemodialysis patients.
abstract: BACKGROUND
  Although hypocholesterolemia is common in chronic hemodialysis patients, its effect on survival has not been studied in a large patients population.
  
  
  METHODS
  A cohort of chronic hemodialysis patients (N = 1167) was prospectively followed from January 1991 to January 2001. The survival impact of this cohort, who were divided according to different baseline levels of serum cholesterol, were calculated with the multivariate Cox proportional hazard analysis after adjusting for baseline clinical and laboratory variables.
  
  
  RESULTS
  During the study period, 567 (48.6%) patients died. The mean (SD) baseline level of serum cholesterol was 171.0 (40.8) mg/dL and ranged from 76 to 378 mg/dL. The five-year survival rate was highest (0.812) in the subgroup that had a serum cholesterol range of 200 to 219 mg/dL and was lowest (0.608) in the subgroup with serum cholesterol values of <140 mg/dL. The five-year survival rate was 0.735 in the subgroup with serum cholesterol of > or =220 mg/dL. Serum cholesterol was a significant predictor of death with an adjusted hazards ratio (95% confidence interval) was 0.939 (0.891 to 0.989). In a subgroup of patients with serum albumin values > or =4.5 g/dL (N = 128), the adjusted hazards ratio was even greater at 1.370 (1.105 to 1.692). Other than sex, body mass index and serum albumin were significant determinants of baseline levels of serum cholesterol.
  
  
  CONCLUSIONS
  Hypocholesterolemia was an independent predictor of death in patients on chronic hemodialysis. This impact of hypercholesterolemia on survival was only evident in a subgroup of patients whose serum albumin was more than 4.5 g/dL.
authors.affiliation: Dialysis Unit and Third Department of Internal Medicine, University of The Ryukyus, Okinawa, Japan. chihokun@med.u-ryukyu.ac.jp
authors.forename: Kunitoshi
authors.initials: K
authors.lastname: Iseki
authors.forename: Masanobu
authors.initials: M
authors.lastname: Yamazato
authors.forename: Masahiko
authors.initials: M
authors.lastname: Tozawa
authors.forename: Shuichi
authors.initials: S
authors.lastname: Takishita
mesh_terms: D002784:Cholesterol / Q000097:blood*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood* / Q000401:mortality* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D006435:Renal Dialysis
chemical_list: D002784:Cholesterol