title: Lipid levels and renal function decline in pre-dialysis patients.
abstract: BACKGROUND
  Little is known about the effect of low-density lipoprotein (LDL) cholesterol, triglyceride (TG), and high-density lipoprotein (HDL) cholesterol levels on renal function decline in patients receiving specialized pre-dialysis care.
  
  
  METHODS
  In the prospective PREPARE-2 study, incident patients starting pre-dialysis care were included when referred to one of the 25 participating Dutch specialized pre-dialysis outpatient clinics (2004-2011). Clinical and laboratory data were collected every 6 months. A linear mixed model was used to compare renal function decline between patients with LDL cholesterol, TG, or HDL cholesterol levels above and below the target goals (LDL cholesterol: <2.50 mmol/l, TG: <2.25 mmol/l, and HDL cholesterol: ≥1.00 mmol/l). Additionally the HDL/LDL cholesterol ratio was investigated (≥0.4).
  
  
  RESULTS
  In our study population (n = 306), the median age was 69 years and 70% were male. Patients with LDL cholesterol levels above the target of 2.50 mmol/l experienced an accelerated renal function decline compared to patients with levels below the target (crude additional decline: 0.10 ml/min/1.73 m(2)/month, 95% CI 0.00-0.20; p < 0.05). A similar trend was found for TG levels above the target of 2.25 mmol/l (0.05 ml/min/1.73 m(2)/month, 95% CI -0.06 to 0.16) and for a HDL/LDL cholesterol ratio below 0.4 (0.06 ml/min/1.73 m(2)/month, 95% CI -0.05 to 0.18). Adjustment for potential confounders resulted in similar results, and the exclusion of patients who were prescribed lipid-lowering medication (statin, fibrate, or cholesterol absorption inhibitor) resulted in a slightly larger estimated effect.
  
  
  CONCLUSIONS
  High levels of LDL cholesterol were associated with an accelerated renal function decline, independent of the prescription of lipid-lowering medication.
authors: Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands.
authors: Moniek C M
authors: MC
authors: de Goeij
authors: Department of Nephrology, Leiden University Medical Center, Leiden, The Netherlands.
authors: Joris I
authors: JI
authors: Rotmans
authors: Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands.
authors: Xanthe
authors: X
authors: Matthijssen
authors: Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands.
authors: Dinanda J
authors: DJ
authors: de Jager
authors: Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands.
authors: Friedo W
authors: FW
authors: Dekker
authors: Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands ; Department of Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK.
authors: Nynke
authors: N
authors: Halbesma
keywords: CKD stages IV–V; Fibrate; Lipids; Pre-dialysis care; Renal function decline; Statin