Nonfasting non-high-density lipoprotein cholesterol is adequate for lipid management in hemodialysis patients.
BACKGROUND
Guidelines for the management of dyslipidemia in patients with chronic kidney disease are based on results from the fasting lipid profile, which can be difficult to obtain from patients on an afternoon or night dialysis schedule. The present study tests the hypothesis that nonfasting non-high-density lipoprotein (HDL) cholesterol (total cholesterol-HDL cholesterol) results are similar to fasting non-HDL results as a basis for the management of dyslipidemia in hemodialysis patients.


METHODS
Forty-eight long-term hemodialysis patients with a mean age of 63.6 years (42% with diabetes, 54% administered statins) participated in this study. For the lipid profile, blood samples were drawn after a 12-hour overnight fast (fasting) and again in a nonfasting state before the subsequent hemodialysis session. Data were analyzed by using paired t-test and regression analysis.


RESULTS
Non-HDL cholesterol values were nearly identical regardless of whether the patient was fasting (r2 = 0.995). Only 2 patients (4%) had a nonfasting triglyceride (TG) level greater than 500 mg/dL (> 5.6 mmol/L), which would have required confirmation after an overnight fast. Non-HDL values had the greatest level of correlation (absolute relative difference, 5.7%). When comparing the subgroup of patients with a TG level less than 200 mg/dL (< 2.3 mmol/L), nonfasting non-HDL cholesterol values identified 3 additional patients compared with fasting calculated low-density lipoprotein cholesterol for whom lipid-lowering therapy would have been introduced according to current guidelines.


CONCLUSIONS
In our study, non-HDL cholesterol levels were equivalent whether evaluated in the fasting or nonfasting state. We recommend that nonfasting non-HDL cholesterol level be used for the management of dyslipidemia in hemodialysis patients without imposing a 12-hour fast period.
Desmeules
Simon
S
Department of Medicine, Centre Hospitalier Universitaire de Québec-Hôtel-Dieu de Québec, 11, Côte de Palais, Québec, Canada. simon.desmeules@mail.chuq.qc.ca
Arcand-Bossé
Jean-François
JF
Bergeron
Jean
J
Douville
Pierre
P
Agharazii
Mohsen
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D001055:Apolipoproteins B / Q000097:blood; D019090:Case Management; D002784:Cholesterol / Q000097:blood*; D008076:Cholesterol, HDL / Q000145:classification; D008078:Cholesterol, LDL / Q000097:blood; D015243:Cholesterol, VLDL / Q000097:blood; D048909:Diabetes Complications / Q000097:blood; D005215:Fasting / Q000097:blood; D005260:Female; D006801:Humans; D006949:Hyperlipidemias / Q000097:blood* / Q000188:drug therapy; D000960:Hypolipidemic Agents / Q000627:therapeutic use; D007676:Kidney Failure, Chronic / Q000097:blood* / Q000150:complications / Q000628:therapy; D008074:Lipoproteins / Q000097:blood; D008297:Male; D008875:Middle Aged; D019518:Postprandial Period; D011237:Predictive Value of Tests; D006435:Renal Dialysis; D014280:Triglycerides / Q000097:blood
D001055:Apolipoproteins B; D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D015243:Cholesterol, VLDL; D000960:Hypolipidemic Agents; D008074:Lipoproteins; D014280:Triglycerides; C030104:lipoprotein cholesterol; D002784:Cholesterol