Effect Of Baseline Remnant Cholesterol Levels On Survival In Maintenance Hemodialysis Patients

Objective:To explore the effect of baseline serum remnant cholesterol(RC)levels on all-cause mortality and cardiovascular and cerebrovascular mortality in patients of maintenance hemodialysis(MHD).Methods:A retrospective analysis was conducted of 141 patients who first received MHD treatment in the dialysis center of the Department of Renal Medicine from January1,2014 to December 31,2019 at the Affiliated Hospital of Yan’an University and met the inclusion criteria.Followed up these patients until December 31,2022.Record the patients’ general information: age,gender,primary disease,complications,dialysis mode,dialysis vascular access;Baseline laboratory indicators: hemoglobin(Hb),triglycerides(TG),remnant cholesterol(RC),total cholesterol(TC),low density lipoprotein cholesterol(LDLC),high density lipoprotein cholesterol(HDLC),calcium(Ga),phosphorus(P),magnesium(Mg),serum creatinine(Scr),blood urea nitrogen(BUN),serum uric acid(SUA),alkaline phosphatase(ALP),parathyroid hormone(PTH),albumin(Alb),β2-Microglobulin(β2-MG);Cardiac ultrasound indicators: Left ventricular ejection fraction(LVEF),left ventricular hypertrophy,and cardiac valve calcification;Record the number of endpoint events and the cause of death.Using the RC value and prognosis of MHD patients as a ROC curve to obtain the optimal cutoff value,the study subjects were divided into two groups:(1)low RC group:<0.745 mmol/L(68 cases);(2)High RC group: ≥ 0.745 mmol/L(73 cases).SPSS 26.0 software was used for statistical processing and statistical analysis of various indicators.Kaplan-Meier method was used to compare the effects of RC levels on all-cause mortality and cardiovascular mortality in MHD patients between the two groups.Log-rank test was used for significance testing,and Cox regression was used to analyze independent related factors of death in MHD patients.Results: 1.A total of 141 patients were included in this study,with an average initial dialysis age of 50.52 ± 14.95 years,of which 70.9% were male and 29.1% were female;The median follow-up time was 49 months.The median baseline RC level in the study subjects was 0.76 mmol/L,with a minimum of 0.07 mmol/L and a maximum of2.83 mmol/L.2.There were a total of 66 cases of all-cause deaths in the study,including 47 deaths from cardiovascular and cerebrovascular diseases,which were the primary cause of death in dialysis patients.The all-cause mortality(HR=2.035,95% CI=1.149-3.605,P=0.015)and cardiovascular and cerebrovascular mortality(HR=3.841,95%CI=1.701-8.672,P=0.001)rates in the high RC group were higher than those in the low RC group,with a statistically significant difference.3.In this study,using COX regression analysis,when all-cause death was the endpoint event:(1)In general data,initial dialysis age,smoking,and taking lipid-lowering drugs were independent risk factors.(2)Among laboratory and cardiac ultrasound indicators,RC(grouping)and BUN were independent risk factors for the occurrence of endpoint events;Mg,Alb,and LVEF were protective factors.When cardiovascular death is the endpoint event:(1)In general data,a history of smoking is an independent risk factor for cardiovascular death.(2)Among laboratory and cardiac ultrasound indicators,RC(grouping),BUN were independent influencing factors for the occurrence of endpoint events.Mg,and LVEF were protective factors.Conclusions:1.High pre dialysis RC level is an independent risk factor for all cause death and cardiovascular and cerebrovascular death in MHD patient.2.Older initial dialysis age,a history of smoking,taking lipid-lowering drugs,and high BUN levels are independent risk factors for all-cause death in MHD patients.Smoking history and high BUN levels are independent risk factors for cardiovascular and cerebrovascular death in MHD patients.3.Alb,Mg,and LVEF are protective factors for the prognosis of MHD patients.