title: Prognostic role of LDL cholesterol in non-dialysis chronic kidney disease: Multicenter prospective study in Italy.
abstract: OBJECTIVE
  The prognostic role of LDL in non-dialysis chronic kidney disease (CKD) is still undefined. We addressed this question in a multicenter prospective study including patients referred to nephrologist for management.
  
  
  RESULTS
  1306 patients with CKD stage III-V were studied at basal visit in 79 Italian nephrology clinics in 2004-2006, and then followed for survival analyses. Study endpoints were incident cardiovascular -CV events (fatal and major non-fatal) and renal events (start of renal replacement therapy or eGFR halving). Mean age was 67.6 ± 11.8 years, male 65%, diabetes 25%, CV disease 27%, and eGFR 35.8 ± 12.5 mL/min/1.73 m(2). LDL was 119 ± 40 mg/dL, with high levels in 50.1% and 82.8% defined on the basis of the individual CV risk profile estimated according to ATPIII 2001 and ESC 2012 guidelines (LDL 100 to 160, and >70 or >100 mg/dL, respectively). Over a median follow up of 2.87 years, 178 CV and 181 renal events occurred. At multivariable Cox analyses, CV risk linearly increased with higher LDL (hazard ratio-HR per 40 mg/dL higher LDL: 1.20, 95% confidence intervals-CI 1.03-1.39); risk doubled when considering high LDL defined according to ESC 2012 (HR 2.37, 95%CI 1.39-4.03) while this association was not significant when considering the higher threshold levels of ATPIII 2001 (HR 1.10, 95%CI 0.82-1.49). No association emerged between LDL and renal risk.
  
  
  CONCLUSIONS
  In non-dialysis CKD patients, CV risk increases linearly with higher LDL and is more than doubled when considering the lower threshold values currently indicated for defining optimal LDL level.
authors.affiliation: Nephrology at the Second University of Naples, Italy. Electronic address: luca.denicola@unina2.it.
authors.forename: Luca
authors.initials: L
authors.lastname: De Nicola
authors.affiliation: Nephrology at the Second University of Naples, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Provenzano
authors.affiliation: Medical Statistics Unit at the Second University of Naples, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Chiodini
authors.affiliation: Nephrology, Center of National Research-Institute of Biomedicine and Molecular Immunology, Reggio Calabria, Italy.
authors.forename: Graziella
authors.initials: G
authors.lastname: D'Arrigo
authors.affiliation: Nephrology, Center of National Research-Institute of Biomedicine and Molecular Immunology, Reggio Calabria, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Tripepi
authors.affiliation: Nephrology-A. Manzoni Hospital, Lecco, Italy.
authors.forename: Lucia
authors.initials: L
authors.lastname: Del Vecchio
authors.affiliation: Nephrology at the Second University of Naples, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Conte
authors.affiliation: Nephrology-A. Manzoni Hospital, Lecco, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Locatelli
authors.affiliation: Nephrology, Center of National Research-Institute of Biomedicine and Molecular Immunology, Reggio Calabria, Italy.
authors.forename: Carmine
authors.initials: C
authors.lastname: Zoccali
authors.affiliation: Nephrology at the Second University of Naples, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Minutolo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000097:blood* / Q000453:epidemiology; D002784:Cholesterol / Q000097:blood*; D008078:Cholesterol, LDL / Q000097:blood*; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007558:Italy / Q000453:epidemiology; D007677:Kidney Function Tests / Q000379:methods; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000097:blood* / Q000503:physiopathology; D012307:Risk Factors; D012720:Severity of Illness Index
chemical_list: D008078:Cholesterol, LDL; D002784:Cholesterol
keywords: Cardiovascular risk; Cholesterol; Chronic kidney disease; ESRD; LDL; Nephrology; Renal clinic