The association of lipid-modifying medications with mortality in patients on long-term peritoneal dialysis.
BACKGROUND
The effect of lipid-lowering therapy on clinical outcomes in peritoneal dialysis patients has not been carefully addressed.


METHODS
Secondary analysis of a retrospective cohort study.


METHODS
Data from 1,053 incident peritoneal dialysis patients from the US Renal Data System prospective Dialysis Morbidity and Mortality Wave 2 study.


METHODS
Use of lipid-modifying medications (93% statins, 7% other medications).


METHODS
Cox regression with propensity score adjustment was used to evaluate time to cardiovascular or all-cause mortality during a 2-year follow-up period. Subgroups based on predefined cutoff values for serum total cholesterol or triglycerides, presence of diabetes, and comorbidity index were analyzed separately.


RESULTS
Use of lipid-modifying medications was associated with decreased all-cause (hazard ratio [HR], 0.74; 95% confidence interval, 0.56 to 0.98) and cardiovascular (HR, 0.67; 95% confidence interval, 0.47 to 0.95) mortality compared with no use of lipid-modifying medications. In subgroup analyses, use of lipid-modifying medications was associated with decreased all-cause mortality (HR, 0.46; 95% confidence interval, 0.22 to 0.95) in the subgroups with cholesterol levels of 226 to 275 mg/dL (HR, 0.27; 95% confidence interval, 0.09 to 0.80) and cholesterol levels greater than 275 mg/dL and cardiovascular mortality (HR, 0.31; 95% confidence interval, 0.11 to 0.85) in the subgroup with cholesterol levels of 226 to 275 mg/dL. Use of lipid-modifying medications also was associated with decreased cardiovascular mortality (HR, 0.64; 95% confidence interval, 0.41 to 0.99) in patients with diabetes and decreased all-cause (HR, 0.65; 95% confidence interval, 0.45 to 0.94) and cardiovascular mortality (HR, 0.55; 95% confidence interval, 0.35 to 0.87) in those with Charlson Comorbidity Index score higher than 2.


CONCLUSIONS
Observational study with retrospective design. Considerable amount of missing data and limited amount of information for the extreme values of cholesterol and triglycerides.


CONCLUSIONS
These observational data suggest that lipid-modifying medication therapy may be associated with improved clinical outcomes in peritoneal dialysis patients.
Goldfarb-Rumyantzev
Alexander S
AS
Division of Nephrology and Hypertension, University of Utah School of Medicine, Salt Lake City, UT, USA. agoldfar@bidmc.harvard.edu
Habib
Arsalan N
AN
Baird
Bradley C
BC
Barenbaum
Lev L
LL
Cheung
Alfred K
AK
D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000401:mortality; D015897:Comorbidity; D003928:Diabetic Nephropathies / Q000453:epidemiology / Q000401:mortality / Q000628:therapy; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D006937:Hypercholesterolemia / Q000188:drug therapy / Q000453:epidemiology; D000960:Hypolipidemic Agents / Q000627:therapeutic use*; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000401:mortality* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome
D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D000960:Hypolipidemic Agents