Dietary Cholesterol And Serum Cholesterol And Survival In Maintenance Hemodialysis Patients

BackgroundCardiovascular disease(CVD)is the main cause of death in maintenance hemodialysis(MHD)patients.Elevated total cholesterol(TC)was recognized conventional risks factor of CVD in general population,the notion that elevated TC is resultant from dietary intake cholesterol was universally accepted.However,the relationship between dietary cholesterol and serum TC in MHD patients is unclear,and no research has explore the association between dietary cholesterol and mortality in MHD patients.Previous studies have reported that elevated serum lipids are associated with improve survival in MHD patients and this paradoxical association are the results of confounding by the malnutrition-inflammation complex syndrome(MICS).Besides,treatments strategies focused on lowering(low-density lipoproteins cholesterol,LDL-C)primarily by the use of statins did not reduce the risk of CVD mortality in MHD patients,suggesting that MHD patients may not be suitable for blood lipid management programs and standards in the general population.ObjectiveA multicenter prospective cohort study was conducted to analyze the correlation between dietary cholesterol and mortality in MHD patients.At the same time,we also explore the association between serum TC and mortality.Study population and MethodsThis study was a multicenter,prospective cohort study.A total of 967 MHD patients were enrolled in eight outpatients dialysis centers in Guangdong Province.Data collection was conducted by trained research staffs.The baseline data included demographic information,history of disease,history of medications,three-day non-consecutive 24-hour dietary review survey,physical examination and blood sample.All participants were followed up until June 2019.The primary outcome was all-cause mortality,and the secondary outcome was cardiovascular(CV)mortality.Multivariate Logistic regression was used to analyze the association between dietary cholesterol and the risk of hypercholesterolemia.Kaplan-Meier survival curves and log-rank test were used to compare survival between groups.Multivariate Cox proportional hazard model was used to analyze the relationship between dietary cholesterol and all-cause death,cardiovascular death,and the correlation between serum TC and all-cause death,cardiovascular death and stroke death.ResultsThe participants’ mean age was 53.48years,57.60%were male,the baseline TC was 159.15±42.83mg/dL,the baseline dietary cholesterol intake was 243.64±156.69mg/d.Compared with patients with dietary cholesterol intake less than 300 mg/d,patients with dietary cholesterol intake more than 300 mg/d had an increased risk of hypercholesterolemia(OR=1.19,95%CI:0.75-1.90).During the median follow-up of 45 months,320 patients died(total mortality 33.1%).Of these,188(CV mortality 19.4%)were attributed to CVD death.After adjusted the potential confounders,dietary cholesterol was not significantly associated with all-cause mortality in MHD patients.Compared with the reference quantile 3(214.24-331.10mg/d),the quantile 1(<125.97mg/d)had higher but not significantly risk for all-cause mortality(HR=1.23,95%CI:0.87-1.75),the HR for all-cause mortality in quantile 2(126.65-213.63mg/d)was 1.35(95%CI:0.96-1.90),and HR for all-cause mortality in quantile 4(≥331.15mg/d)was 1.15(95%CI:0.82-1.60).The CV mortality showed a similar but not significantly trend.Besides,the risk for stroke in quantile 1 and quantile 2 had significantly increased(quartile 1:HR=2.84,95%CI:1.08-7.44;quartile 2:HR=3.20,95%CI:1.23-8.32),and the HR for quartile 4 was 3.55(95%CI:1.39-9.03).However,TC was significantly associated with the mortality in MHD patients.Compared with the reference quantile(<190.26mg/dL),the quantile 5(≥190.64mg/dL)had significantly higher risk for all-cause mortality(HR=1.51,95%CI:1.14-2.01).The CV mortality showed a similar but not significantly trend.Compared with the reference quantile(<164.73mg/dL),the quantile 5(≥190.64mg/dL)had higher but not significantly risk for CV mortality(HR=1.43,95%CI:0.96-2.15).In addition,the risk for stroke in quantile 4(165.12-190.26mg/dL)and quantile 5(≥190.64mg/dL)had significantly increased(quartile 4:HR=1.91,95%CI:1.00-3.64;quartile 5:HR=2.49,95%CI:1.28-4.86).Conclusion1.Too little or too much dietary cholesterol intake was an independent risk factor for stroke mortality in MHD patients.2.Total cholesterol was positively associated with the mortality in MHD patients.Serum total cholesterol≥190.64mg/dL had significantly higher risk for all-cause mortality.Serum total cholesterol≥165.12mg/dL significantly increase the risk for stroke.3.Dietary cholesterol intake was not significantly associated with the risk for hypercholesterolemia.