Relationship of serum total cholesterol and triglyceride with risk of mortality in maintenance hemodialysis patients: a multicenter prospective cohort study

Figures & data

Table 1. The basic characteristics of study participants.

Variables	Total	Total cholesterol, mg/dL				p-Value
		Q1 (<131.1)	Q2 (131.5–154.7)	Q3 (155.1–182.5)	Q4 (≥182.9)
N	1036	256	256	260	264
Demographics
Age, years	54.1 ± 15.1	50.6 ± 16.2	52.4 ± 14.9	54.8 ± 14.8	58.4 ± 13.4	<0.001
Male, n(%)	600 (57.9)	177 (69.1)	168 (65.6)	138 (53.1)	117 (44.3)	<0.001
Current smoking, n(%)	150 (14.5)	53 (20.7)	43 (16.8)	26 (10.0)	28 (10.6)	0.008
Current alcohol drinking, n(%)	38 (3.7)	8 (3.1)	8 (3.1)	10 (3.8)	12 (4.5)	0.005
Diabetes, n(%)	277 (26.7)	68 (26.6)	56 (21.9)	58 (22.3)	95 (36.0)	<0.001
Hypertension, n(%)	891 (86.0)	219 (85.5)	218 (85.2)	225 (86.5)	229 (86.7)	0.945
History of CVD, n(%)	200 (19.3)	54 (21.1)	39 (15.2)	47 (18.1)	60 (22.7)	0.140
Lipid-lowering agent use, n(%)						0.678
Statins	61 (5.9)	11 (4.3)	15 (5.9)	16 (6.2)	19 (7.2)
Fenofibrate	4 (0.4)	1 (0.4)	0 (0.0)	1 (0.4)	2 (0.8)
Dialysis vintage, months†	24.4 (12.4-50.5)	21.6 (11.8-50.5)	24.3 (13.4-45.5)	29.6 (12.5-55.3)	23.6 (11.3-49.4)	0.200
Physical examination
BMI, kg/m^2	21.2 ± 3.4	20.8 ± 3.1	21.1 ± 3.4	21.0 ± 3.1	22.1 ± 3.7	<0.001
WHR	0.90 ± 0.07	0.89 ± 0.08	0.90 ± 0.06	0.90 ± 0.07	0.92 ± 0.07	<0.001
Biochemistry
Albumin, g/dL	3.81 ± 0.38	3.81 ± 0.38	3.83 ± 0.36	3.80 ± 0.42	3.79 ± 0.37	0.650
Total cholesterol, mg/dL	159.9 ± 43.4	111.3 ± 17.5	143.1 ± 6.7	167.3 ± 7.7	215.9 ± 35.2	<0.001
Triglyceride, mg/dL	164.4 ± 121.8	123.4 ± 80.0	140.2 ± 81.8	156.4 ± 92.8	235.7 ± 172.8	<0.001
Calcium, mg/dL	8.7 ± 1.0	8.5 ± 1.0	8.6 ± 1.0	8.8 ± 1.1	8.9 ± 1.1	<0.001
Phosphate, mg/dL	6.6 ± 2.0	6.4 ± 2.0	6.7 ± 2.0	6.6 ± 2.0	6.8 ± 1.9	0.265
Hemoglobin, g/dL	10.7 ± 2.1	10.5 ± 2.2	10.9 ± 2.0	10.6 ± 2.1	10.9 ± 2.0	0.045
CRP, mg/L†	2.7 (1.0-7.3)	2.6 (0.9-7.0)	2.2 (0.9-5.6)	2.4 (0.8-8.0)	3.6 (1.3-9.5)	0.384
Kt/V ratio†	1.30 (1.10-1.50)	1.2 (1.1-1.5)	1.3 (1.1-1.5)	1.3 (1.1-1.5)	1.3 (1.1-1.5)	0.611
Dietary parameters
DPI, g/kg/d	1.1 ± 0.4	1.1 ± 0.3	1.1 ± 0.3	1.1 ± 0.4	1.0 ± 0.4	0.119
DEI, kcal/kg/d	29.1 ± 8.3	29.4 ± 8.5	28.9 ± 8.3	29.7 ± 8.6	28.4 ± 7.9	0.303
Dietary cholesterol, mg/d	244.4 ± 175.0	231.4 ± 142.7	227.7 ± 152.9	257.8 ± 161.6	260.1 ± 227.1	0.060

Data are expressed as mean ± SD; †data are expressed as median with interquartile range (Q1–Q3).

Abbreviations: CVD: cardiovascular diseases; BMI: body mass index; WHR: waist: hip ratio; CRP: C-reactive protein; DPI: dietary protein intake; DEI: dietary energy intake.

Figure 1. Relationship of serum total cholesterol levels (A) and triglyceride levels (B) with the risk of all-cause mortality*. *Adjusted for age, sex, dialysis center, diabetes, hypertension and history of CVD, smoking, alcohol drinking, lipid-lowering agent use, dialysis vintage, Kt/V ratio, BMI, waist:hip ratio, albumin, serum calcium, hemoglobin, CRP (log₁₀ transformed), dietary energy intake, dietary cholesterol intake and serum triglyceride or serum total cholesterol.

Table 2. The association between total cholesterol levels and the risk of mortality.

Total cholesterol, mg/dL	No. events (%)	Model I^a		Model II^b
		HR (95%CI)	p-Value	HR (95%CI)	p-Value
All-cause mortality
Quartiles
Q1 (<131.1)	127 (49.6)	1.0 (Ref)	–	1.0 (Ref)	–
Q2 (131.5–154.7)	117 (45.7)	0.81 (0.63, 1.04)	0.100	0.82 (0.63, 1.06)	0.125
Q3 (155.1–182.5)	134 (51.5)	0.94 (0.73, 1.21)	0.630	0.92 (0.71, 1.18)	0.517
Q4 (≥182.9)	171 (64.8)	1.11 (0.88, 1.42)	0.380	1.30 (1.00, 1.68)	0.048
Categories
Q1–Q3 (<182.5)	378 (49.0)	1.0 (Ref)	–	1.0 (Ref)	–
Q4 (≥182.9)	171 (64.8)	1.22 (1.01, 1.47)	0.040	1.43 (1.17, 1.76)	0.001
CVD mortality
Quartiles
Q1 (<131.1)	67 (26.2)	1.0 (Ref)	–	1.0 (Ref)	–
Q2 (131.5–154.7)	64 (25.0)	0.86 (0.61, 1.22)	0.388	0.89 (0.63, 1.26)	0.515
Q3 (155.1–182.5)	75 (28.8)	0.99 (0.71, 1.38)	0.942	0.97 (0.69, 1.37)	0.879
Q4 (≥182.9)	91 (34.5)	1.05 (0.76, 1.47)	0.754	1.30 (0.91, 1.86)	0.154
Categories
Q1–Q3 (<182.5)	206 (26.7)	1.0 (Ref)	–	1.0 (Ref)	–
Q4 (≥182.9)	91 (34.5)	1.11 (0.86, 1.44)	0.425	1.36 (1.03, 1.80)	0.031

^aAdjusted for age, sex, dialysis center, diabetes, hypertension and history of CVD. ^bAdjust for Model I covariates and smoking, alcohol drinking, lipid-lowering agent use, dialysis vintage, Kt/V ratio, BMI, waist:hip ratio, albumin, triglyceride, serum calcium, hemoglobin, CRP (log₁₀ transformed), dietary energy intake and dietary cholesterol intake.

Table 3. The association between triglyceride levels and the risk of mortality.

Triglyceride, mg/dL	No. events (%)	Model I^a		Model II^b
		HR(95%CI)	p-Value	HR(95%CI)	p-Value
All-cause mortality
Quartiles
Q1 (<87.7)	134 (52.3)	1.0 (Ref)	–	1.0 (Ref)	–
Q2 (88.5–131.0)	133 (50.8)	0.87 (0.68, 1.11)	0.253	0.85 (0.66, 1.09)	0.210
Q3 (131.9–193.0)	138 (53.3)	0.88 (0.69, 1.13)	0.318	0.88 (0.68, 1.14)	0.334
Q4 (≥193.9)	144 (55.6)	0.80 (0.63, 1.03)	0.081	0.70 (0.52, 0.93)	0.015
Categories
Q1–Q3 (<193.0)	405 (52.1)	1.0 (Ref)	–	1.0 (Ref)	–
Q4 (≥193.9)	144 (55.6)	0.88 (0.72, 1.07)	0.212	0.78 (0.63, 0.98)	0.033
CVD mortality
Quartiles
Q1 (<87.7)	78 (30.5)	1.0 (Ref)	–	1.0 (Ref)	–
Q2 (88.5–131.0)	76 (29.0)	0.80 (0.58, 1.11)	0.184	0.80 (0.58, 1.12)	0.197
Q3 (131.9–193.0)	72 (27.8)	0.75 (0.54, 1.04)	0.084	0.81 (0.57, 1.16)	0.252
Q4 (≥193.9)	71 (27.4)	0.62 (0.44, 0.86)	0.005	0.60 (0.41, 0.90)	0.013
Categories
Q1–Q3 (<193.0)	226 (29.1)	1.0 (Ref)	–	1.0 (Ref)	–
Q4 (≥193.9)	71 (27.4)	0.74 (0.56, 0.97)	0.031	0.72 (0.53, 0.98)	0.036

^aAdjusted for age, sex, dialysis center, diabetes, hypertension and history of CVD. ^bAdjust for Model I covariates and smoking, alcohol drinking, lipid-lowering agent use, dialysis vintage, Kt/V ratio, BMI, waist:hip ratio, albumin, serum total cholesterol, serum calcium, hemoglobin, CRP (log₁₀ transformed), dietary energy intake and dietary cholesterol intake.

Figure 2. Joint association of TC and TG with all-cause mortality (A) and CVD mortality (B)*. *Adjusted for age, sex, dialysis center, diabetes, hypertension and history of CVD, smoking, alcohol drinking, lipid-lowering agent use, dialysis vintage, Kt/V ratio, BMI, waist:hip ratio, albumin, serum calcium, hemoglobin, CRP (log₁₀ transformed), dietary energy intake, dietary cholesterol intake.

Figure 3. Stratified analysis of the association between serum total cholesterol (A), triglyceride (B) and the risk of all-cause mortality*. *Adjusted for age, sex, dialysis center, diabetes, hypertension and history of CVD, smoking, alcohol drinking, lipid-lowering agent use, dialysis vintage, Kt/V ratio, BMI, waist:hip ratio, albumin, serum calcium, hemoglobin, CRP (log₁₀ transformed), dietary energy intake, dietary cholesterol intake and serum triglyceride or serum total cholesterol.