Kidney Week

Abstract: SA-PO773

Mortality Risk for Low Density Lipoprotein Cholesterol Across CKD Stages in 1.95 Million US Veterans

Session Information

• CKD: Epidemiology, Risk Factors, Prevention - III
  October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

• 1901 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

• Soohoo, Melissa, Tibor Rubin Long Beach VA Medical Center, Long Beach, California, United States

Melissa Soohoo,

• Moradi, Hamid, Tibor Rubin Long Beach VA Medical Center, Long Beach, California, United States

Hamid Moradi,

• Kleine, Carola-Ellen, Tibor Rubin Long Beach VA Medical Center, Long Beach, California, United States

Carola-Ellen Kleine,

• Marroquin, Maria V., Tibor Rubin Long Beach VA Medical Center, Long Beach, California, United States

Maria V. Marroquin,

• Benson-Hernandez, Taryn B., Harold Simmons Center for Kidney Disease Research and Epidemiology, Orange, California, United States

Taryn B. Benson-Hernandez,

• Kovesdy, Csaba P., University of Tennessee Health Science Center, Memphis, Tennessee, United States

Csaba P. Kovesdy,

• Kalantar-Zadeh, Kamyar, University of California Irvine, School of Medicine, Orange, California, United States

Kamyar Kalantar-Zadeh,

• Streja, Elani, Tibor Rubin Long Beach VA Medical Center, Long Beach, California, United States

Elani Streja,

Background

Prior studies have shown that higher low-density lipoprotein cholesterol (LDL) levels are associated with worse survival in the general population, yet this association is attenuated in chronic kidney disease (CKD) patients. However, the graded impact of kidney disease on the association of LDL with mortality is unclear.

Methods

We investigated a cohort of 1.95 million US veterans with baseline LDL and creatinine data from 2004-2006. Over a median[IQR] follow-up of 10.5[7,11] years, we examined the relationship of baseline LDL with all-cause and cardiovascular (CV) death risk across CKD stage in Cox proportional hazard models adjusted for demographics, comorbid conditions, smoking status, other lipids and prescription of statins and non-statins. CKD stage was determined according to estimated glomerular filtration rate (eGFR) at the time of LDL measurement.

Results

The cohort had a mean±SD age of 65±14 years, and included 5% females, 15% African-Americans, 22% diabetics, 32% statin-users and 44% current smokers. The median[IQR] of baseline LDL was 103[82,128] mg/dL and eGFR was 76[61,91] mL/min/1.73m². Patients with higher LDL were more likely to be younger, African-American, a current smoker, not on a statin, and have a higher eGFR. Patients with lower LDL (<60mg/dL) had a higher risk of all-cause and CV mortality across all stages of CKD, compared to LDL 80-<100 mg/dL. Higher LDL(≥140 mg/dL) was associated with higher all-cause and CV mortality risk in CKD3A and 3B, but these associations were attenuated for CKD4 and 5. Of note, in non-CKD veterans, higher LDL was protective for both CV and all-cause death risk. [Figure]

Conclusion

Elevated LDL ≥140 mg/dL is associated with higher all-cause and CV mortality risk among CKD 3A and 3B, but not among more advanced CKD stages. Future studies are needed to evaluate the impact of lipid lowering therapies and effect of time-updated LDL with mortality risk across CKD stages.

Funding

• Veterans Affairs Support