Journal Article

Dyslipidaemia and the progression of renal disease in chronic renal failure patients

Ziad A. Massy, Thao Nguyen Khoa, Bernard Lacour, Béatrice Descamps-Latscha, Nguyen Khoa Man and Paul Jungers

in Nephrology Dialysis Transplantation

Published on behalf of European Renal Association - European Dialysis and Transplant Assoc

Volume 14, issue 10, pages 2392-2406
Published in print October 1999 | ISSN: 0931-0509
Published online October 1999 | e-ISSN: 1460-2385 | DOI: http://dx.doi.org/10.1093/ndt/14.10.2392
Dyslipidaemia and the progression of renal disease in chronic renal failure patients

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Background. Dyslipidaemia is common in patients with chronic renal failure (CRF), and there is increasing evidence to support the role of dyslipidaemia as a contributing factor in the progression of chronic renal disease. However, few prospective studies have been carried out which address the possible relationship between dyslipidaemia and the rate of progression of renal disease in patients with renal failure.

Methods. Between January 1985 and December 1997, we prospectively assessed the risk of CRF progression to dialysis in a cohort of 138 patients. Forty CRF patients reached end-stage renal disease (ESRD) and had to start supportive therapy during the follow-up period [group ESRD(+)]. The remaining 98 CRF patients served as controls [group ESRD(−)]. Potential clinical and laboratory risk factors for more rapid CRF decline to dialysis, including lipid abnormalities and baseline creatinine clearance were determined at the start of the follow-up period.

Results. Several significant differences were found in univariate analysis between the two groups of CRF, ESRD(+) and ESRD(−), namely a shorter follow-up period, a lower level of baseline creatinine clearance, a faster rate of creatinine clearance decline, a higher level of serum triglycerides, fibrinogen, total homocyst(e)ine and proteinuria, and a lower level of serum high-density lipoprotein in the ESRD(+) group than in the ESRD(−) group. However, by multivariate Cox analysis proteinuria [relative risk (95% confidence interval) 1.32 (1.16–1.50) for each g/day P=0.001], baseline creatinine clearance [0.53 (0.40–0.70) for each 10 ml/min, P=0.001] and chronic interstitial nephritis and hypertensive nephrosclerosis [0.38 (0.17–0.84) for presence, P=0.005] were the only significant risk factors for CRF progression to dialysis. Hypertriglyceridaemia and male gender were selected in the final model, but were of borderline significance.

Conclusions. These results suggest a limited role for dyslipidaemia in the progression of chronic renal disease to dialysis in CRF patients, in contrast with the powerful influence of proteinuria, baseline creatinine clearance and nephropathy type in predicting this progression.

Keywords: chronic renal failure; creatinine clearance; fibrinogen; homocyst(e)ine; lipids; lipoprotein(a)

Journal Article.  3874 words.  Illustrated.

Subjects: Nephrology

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