What is the association of dyslipidemia with CVD and mortality in patients with CKD?
Unlike in the general population, the linear association between higher levels of cholesterol and CVD-related mortality is less evident in patients with CKD, especially those on dialysis. Instead, observational studies have demonstrated a “reverse epidemiology” between total cholesterol levels and mortality in dialysis patients; that is, increased risk at low cholesterol levels, with evidence that malnutrition and chronic inflammation may act as affect modifiers of this association.
Hypercholesterolemia is an independent risk factor for cardiovascular and all-cause mortality in dialysis patients without evidence of malnutrition or inflammation.
Observational data from non-dialysis CKD populations has been conflicting. Data from the Atherosclerosis Risk in Communities (ARIC) study suggested that higher total cholesterol and triglyceride levels were associated with a higher risk of CVD events in patients with CKD.
However, the Cardiovascular Health Study (CHS) and the Modification of Diet in Renal Disease (MDRD) study reported that dyslipidemia was not associated with the increased risk of kidney failure and cause, or CVD mortality.
