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      Association of High-Density Lipoprotein Cholesterol with the Estimated Glomerular Filtration Rate in a Community-Based Population

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          Abstract

          Background

          Reduced kidney function is independently associated with low high-density lipoprotein cholesterol (HDL-C) levels in patients with end-stage renal disease (ESRD), those on hemodialysis, and those with stage 3–5 chronic kidney disease (CKD). However, epidemiological data investigating the relationship between HDL-C levels and kidney function in the general population with roughly normal kidney function are limited, and the results are also inconsistent. The aim of this study was to evaluate the relationship between HDL-C levels and the estimated glomerular filtration rate (eGFR) in a community-based population in China.

          Methods

          This was a community-based cross-sectional survey. In total, 4925 participants (age range, 18–96 years; mean, 51.30±11.98 years) were recruited during routine health status examinations. A questionnaire was used to ascertain age, smoking status, and the history of hypertension and diabetes mellitus for each participant. We measured the body mass index, waist circumference, systolic and diastolic blood pressure, and fasting glucose, total cholesterol, triglyceride, HDL-C, low-density lipoprotein cholesterol, uric acid, and serum creatinine level of each participant. eGFR was evaluated using the Chinese modified Modification of Diet in Renal Disease equation.

          Results

          The HDL-C level was higher in the first quartile (lowest quartile) of eGFR than in the fourth quartile (the highest quartile). Additionally, HDL-C levels decreased as eGFR decreased. Pearson’s correlation analysis revealed that HDL-C levels were associated with eGFR (r=0.16). After adjustment for some confounders, HDL-C was independently associated with all quartiles of eGFR in the participants.

          Conclusions

          HDL-C was independently associated with kidney function in a community-dwelling general population. The association between low HDL-C levels and a decreased eGFR gradually strengthened as eGFR declined.

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          Lipid-lowering therapy in persons with chronic kidney disease: a systematic review and meta-analysis.

          Ashish Kumar Upadhyay, Amy Earley, Jenny L. Lamont … (2012)
          Lipid-lowering therapy is not widely used in persons with chronic kidney disease (CKD) despite a high burden of dyslipidemia and cardiovascular disease in this population. To synthesize evidence examining the effect of lipid-lowering therapy on clinical outcomes in persons with CKD. MEDLINE, the Cochrane Central Register of Controlled Trials, and the Cochrane Database of Systematic Reviews from January 2000 through November 2011. Randomized, controlled trials (RCTs) comparing lipid-lowering therapy with control treatment in persons with CKD, including subgroup analyses of trials in the general population. Abstracts were screened and data were extracted on study methodology, population, interventions, cardiovascular and kidney outcomes, and adverse events. Data were extracted by one author and confirmed by another. Study quality was determined by consensus. Random-effects model meta-analyses were performed. 18 RCTs, all in adults, met the eligibility criteria. Five RCTs involved CKD populations, and 13 were CKD subgroup analyses from trials in the general population. Sixteen RCTs examined statins, and 2 examined statins plus ezetimibe. Lipid-lowering therapy does not improve kidney outcomes but decreases the risk for cardiac mortality (pooled risk ratio [RR] from 6 trials, 0.82 [95% CI, 0.74 to 0.91]; P< 0.001), cardiovascular events (including revascularization) (pooled RR from 9 trials, 0.78 [CI, 0.71 to 0.86]; P< 0.001), and myocardial infarction (pooled RR from 9 trials, 0.74 [CI, 0.67 to 0.81]; P< 0.001). Significant benefit was also seen for all-cause mortality but was limited by a high degree of heterogeneity. No benefit was found for other cardiovascular outcomes. Rates of adverse events were similar between intervention and comparator groups. Lack of data in children, heterogeneity among reviewed studies, and the possibility of selective reporting of outcomes and adverse events. Lipid-lowering therapy decreases cardiac death and atherosclerosis-mediated cardiovascular events in persons with CKD.
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            Low HDL Cholesterol and the Risk of Diabetic Nephropathy and Retinopathy

            Jamie Morton, Sophia Zoungas, Qiang Li … (2012)
            OBJECTIVE Although low HDL cholesterol (HDL-C) is an established risk factor for atherosclerosis, data on HDL-C and the risk of microvascular disease are limited. We tested the association between HDL-C and microvascular disease in a cohort of patients with type 2 diabetes. RESEARCH DESIGN AND METHODS A total of 11,140 patients with type 2 diabetes and at least one additional vascular risk factor were followed a median of 5 years. Cox proportional hazards models were used to assess the association between baseline HDL-C and the development of new or worsening microvascular disease, defined prospectively as a composite of renal and retinal events. RESULTS The mean baseline HDL-C level was 1.3 mmol/L (SD 0.45 mmol/L [range 0.1–4.0]). During follow-up, 32% of patients developed new or worsening microvascular disease, with 28% experiencing a renal event and 6% a retinal event. Compared with patients in the highest third, those in the lowest third had a 17% higher risk of microvascular disease (adjusted hazard ratio 1.17 [95% CI 1.06–1.28], P = 0.001) after adjustment for potential confounders and regression dilution. This was driven by a 19% higher risk of renal events (1.19 [1.08–1.32], P = 0.0005). There was no association between thirds of HDL-C and retinal events (1.01 [0.82–1.25], P = 0.9). CONCLUSIONS In patients with type 2 diabetes, HDL-C level is an independent risk factor for the development of microvascular disease affecting the kidney but not the retina.
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              Association between body mass index and chronic kidney disease in men and women: population-based study of Malay adults in Singapore.

              V Leng, Tien-Yin Wong, Anoop Shankar … (2008)
              In contrast to previous studies from western populations, studies from Japan reported a positive association between body mass index (BMI) and chronic kidney disease (CKD) among men but not women. In this context, we examined the relationship between BMI and CKD, by gender, in a study of Malay adults from Singapore. This was a population-based cross-sectional sample of adults (n = 2783, 53% women, aged 49-80 years), free of clinical cardiovascular disease. The outcome of interest was presence of CKD [estimated glomerular filtration rate (eGFR) or=30 kg/m(2)); P-trend < 0.0001. In contrast, among women BMI levels were not associated with CKD; P-trend = 0.32. In nonparametric models, among men, the observed positive association between BMI and CKD appeared to be present across the full range of BMI values, without any threshold. In contrast, among women, results from nonparametric models were consistent with the conclusion of a lack of association between BMI and CKD. Higher BMI levels were positively associated with CKD among men but not women in a population-based study from Singapore. These results are consistent with the hypothesis of a male gender-specific association between BMI and CKD among Asians.
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                Author and article information

                Contributors
                Antonio Carlos Seguro: Role: Editor
                Journal
                Journal ID (nlm-ta): PLoS One
                Journal ID (iso-abbrev): PLoS ONE
                Journal ID (publisher-id): plos
                Journal ID (pmc): plosone
                Title: PLoS ONE
                Publisher: Public Library of Science (San Francisco, USA )
                ISSN (Electronic): 1932-6203
                Publication date Collection: 2013
                Publication date (Electronic): 6 November 2013
                Volume: 8
                Issue: 11
                Electronic Location Identifier: e79738
                Affiliations
                [1]Department of Geriatric Cardiology, Chinese PLA General Hospital, Beijing, China
                University of São Paulo School of Medicine, Brazil
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Conceived and designed the experiments: FW PY. Performed the experiments: LML LS JZ HMW. Analyzed the data: YYB THX RYX. Contributed reagents/materials/analysis tools: FW. Wrote the manuscript: FW.

                Article
                Publisher ID: PONE-D-13-27974
                DOI: 10.1371/journal.pone.0079738
                PMC ID: 3819240
                PubMed ID: 24223189
                SO-VID: 2cf43469-3591-4fc0-80e1-988e7064d86d
                Copyright statement: Copyright @ 2013
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                Date received : 4 July 2013
                Date accepted : 23 September 2013
                Funding
                This study was supported by a grant from the Key National Basic Research Program of China (2012CB517503, 2013CB530804) and Nature Science Foundation of China (81270941). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Subject: Research Article

                ScienceOpen disciplines: Uncategorized
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