Relation of serum lipids and lipoproteins with progression of CKD: The CRIC study.
OBJECTIVE
Hyperlipidemia is common in patients with CKD. The objective of this study was to evaluate whether measures of plasma lipids and lipoproteins predict progression of kidney disease in patients with CKD.


METHODS
Prospective cohort study in adults (n=3939) with CKD aged 21-74 years recruited between 2003 and 2008 and followed for a median of 4.1 years. At baseline, total cholesterol, triglycerides, very-low-density lipoprotein cholesterol (VLDL-C), LDL cholesterol (LDL-C), HDL cholesterol (HDL-C), apoA-I , apoB, and lipoprotein(a) [Lp(a)] were measured. The outcomes were composite end point of ESRD or 50% decline in eGFR from baseline (rate of change of GFR).


RESULTS
Mean age of the study population was 58.2 years, and the mean GFR was 44.9 ml/min per 1.73 m(2); 48% of patients had diabetes. None of the lipid or lipoprotein measures was independently associated with risk of the composite end point or rate of change in GFR. However, there were significant (P=0.01) interactions by level of proteinuria. In participants with proteinuria<0.2 g/d, 1-SD higher LDL-C was associated with a 26% lower risk of the renal end point (hazard ratio [HR], 0.74; 95% confidence interval [95% CI], 0.59 to 0.92; P=0.01), and 1-SD higher total cholesterol was associated with a 23% lower risk of the renal end point (HR, 0.77; 95% CI, 0.62 to 0.96; P=0.02). In participants with proteinuria>0.2 g/d, neither LDL-C (HR, 0.98; 95% CI, 0.98 to 1.05) nor total cholesterol levels were associated with renal outcomes. Treatment with statins was reported in 55% of patients and was differential across lipid categories.


CONCLUSIONS
In this large cohort of patients with CKD, total cholesterol, triglycerides, VLDL-C, LDL-C, HDL-C, apoA-I, apoB, and Lp(a) were not independently associated with progression of kidney disease. There was an inverse relationship between LDL-C and total cholesterol levels and kidney disease outcomes in patients with low levels of proteinuria.
Department of Medicine, Case Western Reserve University, University Hospitals Case Medical Center, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio; Mahboob.Rahman@uhhospitals.org.
Mahboob
M
Rahman
Center for Clinical Epidemiology and Biostatistics and.
Wei
W
Yang
Division of Nephrology, University of Illinois, Chicago, Illinois;
Sanjeev
S
Akkina
Department of Epidemiology, Tulane University, New Orleans, Louisiana;
Arnold
A
Alper
Center for Clinical Epidemiology and Biostatistics and.
Amanda Hyre
AH
Anderson
Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland;
Lawrence J
LJ
Appel
Department of Epidemiology, Tulane University, New Orleans, Louisiana;
Jiang
J
He
Division of Nephrology, George Washington University, Washington, DC;
Dominic S
DS
Raj
Case Western Reserve University, MetroHealth Medical Center, Cleveland, Ohio; and.
Jeffrey
J
Schelling
University Hospitals Case Medical Center, Cleveland, Ohio.
Louise
L
Strauss
Center for Clinical Epidemiology and Biostatistics and.
Valerie
V
Teal
Division of Translational Medicine and Human Genetics, University of Pennsylvania, Philadelphia, Pennsylvania;
Daniel J
DJ
Rader
D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D018450:Disease Progression; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D006949:Hyperlipidemias / Q000097:blood / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D007668:Kidney / Q000503:physiopathology; D007676:Kidney Failure, Chronic / Q000209:etiology; D008055:Lipids / Q000097:blood*; D008074:Lipoproteins / Q000097:blood*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D065840:Protective Factors; D011507:Proteinuria / Q000209:etiology; D051436:Renal Insufficiency, Chronic / Q000097:blood / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D012307:Risk Factors; D055815:Young Adult
D015415:Biomarkers; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D008055:Lipids; D008074:Lipoproteins
chronic kidney disease; lipids; progression of chronic renal failure