title: Low-density lipoprotein cholesterol: association with mortality and hospitalization in hemodialysis patients.
abstract: OBJECTIVE
  Hypocholesterolemia is a common finding in hospitalized elderly people, critically ill surgical patients, septic patients and end-stage renal disease patients. The different effect of lipid subfractions on patients with end-stage renal disease has never been demonstrated. We aim to study the effect of lipid subfractions on hospitalization and mortality in maintenance hemodialysis (MHD) patients.
  
  
  METHODS
  Lipid subfractions, including total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C) were measured in 210 patients with MHD in a single dialysis center. Patients were stratified into three groups based on the tertiles of lipid levels, and differences in patient characteristics and survival were evaluated.
  
  
  RESULTS
  Of a total of 22 deceased patients in our MHD cohort, infection-related mortality (50%) was higher than cardiovascular-related mortality (18.2%). Significant differences (p < 0.05) in the duration and frequency of hospitalization and in mortality events were observed when patients were divided into different subgroups according to the tertiles of baseline TC and LDL-C levels. Patients with lower LDL had significantly lower levels of albumin, TC and TG. The LDL-C tertiles were similar in terms of age, hypertension, diabetes, biochemical results, hematocrit, adequacy of hemodialysis and normalized protein catabolism rate. Both TC and LDL-C predicted survival (p < 0.001), but not TG and HDL-C in the Kaplan-Meier model. The Cox proportional hazard model demonstrated that baseline serum LDL-C was the best lipid subfraction in predicting all-cause death with an adjusted hazard ratio (95% confidence interval) for each 10 mg/dl of 0.752 (0.631-0.898; p = 0.002).
  
  
  CONCLUSIONS
  We firstly demonstrated that lipid subfractions, including TC and LDL-C, predict poor outcomes in a MHD cohort with high infection-related mortality.
authors.affiliation: Department of Internal Medicine, Far Eastern Memorial Hospital, Taipei, Taiwan.
authors.forename: Chih-Kang
authors.initials: CK
authors.lastname: Chiang
authors.forename: Tai-I
authors.initials: TI
authors.lastname: Ho
authors.forename: Shih-Ping
authors.initials: SP
authors.lastname: Hsu
authors.forename: Yu-Sen
authors.initials: YS
authors.lastname: Peng
authors.forename: Mei-Fen
authors.initials: MF
authors.lastname: Pai
authors.forename: Shao-Yu
authors.initials: SY
authors.lastname: Yang
authors.forename: Kuan-Yu
authors.initials: KY
authors.lastname: Hung
authors.forename: Tun-Jun
authors.initials: TJ
authors.lastname: Tsai
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000401:mortality; D002423:Cause of Death; D008078:Cholesterol, LDL / Q000097:blood*; D005260:Female; D006760:Hospitalization; D006801:Humans; D007239:Infections / Q000401:mortality; D007676:Kidney Failure, Chronic / Q000097:blood* / Q000150:complications / Q000401:mortality; D008055:Lipids / Q000097:blood; D008297:Male; D008875:Middle Aged; D009026:Mortality; D016016:Proportional Hazards Models; D006435:Renal Dialysis; D016019:Survival Analysis
chemical_list: D008078:Cholesterol, LDL; D008055:Lipids