Relation of serum lipids and lipoproteins with progression of CKD: The CRIC study

Mahboob Rahman, Wei Yang, Sanjeev Akkina, Arnold Alper, Amanda Hyre Anderson, Lawrence J. Appel, Jiang He, Dominic S. Raj, Jeffrey Schelling, Louise Strauss, Valerie Teal, Daniel J. Rader

Research output: Contribution to journalArticlepeer-review

Abstract

Background and objectives 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. Design, setting, participants, & measurements 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 holesterol (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 m2; 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, therewere 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 participantswith 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.

Original languageEnglish (US)
Pages (from-to)1190-1198
Number of pages9
JournalClinical Journal of the American Society of Nephrology
Volume9
Issue number7
DOIs
StatePublished - 2014

ASJC Scopus subject areas

  • Epidemiology
  • Critical Care and Intensive Care Medicine
  • Nephrology
  • Transplantation

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