Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

High cholesterol predicts lower mortality in dialysis patients but is not protective

28.01.2004


Kidney dialysis patients with higher cholesterol levels die at a lower rate than those with lower cholesterol levels, which is opposite of the general public. However, a study by researchers at the John Hopkins Bloomberg School of Public Health determined that the lower mortality rate of those with higher cholesterol is likely due to the cholesterol-lowering effects of inflammation and malnutrition, two serious complications of kidney dialysis, and not a benefit of high cholesterol. The study is published in the January 28, 2004, edition of the Journal of the American Medical Association (JAMA).



"Using multiple blood tests we were able to show that the majority of dialysis patients have inflammation and/or malnutrition and these conditions distort the meaning of serum cholesterol. This explains why patients with lower cholesterol have higher mortality," said Josef Coresh, MD, PhD, the study’s senior investigator and an associate professor in the Department of Epidemiology at the School of Public Health. "We were able to show that when dialysis patients don’t have inflammation or malnutrition, higher cholesterol predicted a progressively higher risk of total and cardiovascular mortality. This is important since it undermines the idea that high cholesterol can be protective in dialysis patients and emphasizes the importance of cholesterol treatment," explained Dr. Coresh.

The study included 823 dialysis patients from 79 clinics in the United States. Inflammation and/or malnutrition were detected by looking for abnormalities in any one of three laboratory tests (C-reactive protein, interleukin-6 or serum albumin) since any one test can miss patients with abnormalities. Participants with inflammation or malnutrition had lower cholesterol levels than those without either condition. Overall, higher cholesterol was incrementally associated with lower mortality, a finding which confirms other studies in dialysis patients and other sick populations such as smokers and the elderly. This opposite association from the expected higher mortality at higher cholesterol has led some physicians to avoid treating high cholesterol in dialysis patients. However, among patients without inflammation or malnutrition, higher cholesterol was strongly associated with higher mortality.


Yongmei Liu, MD, the study’s first author and a PhD candidate at the School of Public Health emphasized that the findings were similar when cardiovascular disease was the cause of death. Overall and among participants with inflammation or malnutrition cholesterol was not strongly related to cardiovascular mortality risk. However, among those without inflammation or malnutrition a strong association between higher cholesterol and higher risk was seen. "The same serum cholesterol means different things depending on the presence or absence of inflammation" said Dr. Liu. "In dialysis patients, low serum cholesterol may signal the presence of poor nutritional status or chronic inflammation. Physicians should look for signs of inflammation and malnutrition which can be markers of high risk and distort the meaning of serum cholesterol. These findings are also relevant for other sick populations such as older patients and smokers."

According to Dr. Coresh, "Cardiovascular disease is a leading cause of death for patients with kidney failure. Even though 30 percent of dialysis patients have unhealthy cholesterol levels fewer than 10 percent receive any cholesterol lowering medication. Our findings show that this population should be treated for high cholesterol."


"Association Between Cholesterol and Mortality in Dialysis Patients, Role of Inflammation and Malnutrition" was written by Yongmei Liu, MD; Josef Coresh, MD, PhD; Joseph A. Eustace, MD, MHS; J. Craig Longenecker, MD, PhD; Bernard Jaar, MD, MPH; Nancy E. Fink, MPH; Russell P. Tracy, PhD; Neil R. Powe, MD, MPH, MBA; and Michael Klag, MD, MPH.

The study was funded by grants from the National Heart, Lung, and Blood Institute, the National Institute of Diabetes and Digestive and Kidney Diseases, the American Heart Association and the National Center for Research Resources.

Kenna Brigham | EurekAlert!
Further information:
http://www.jhsph.edu/

More articles from Health and Medicine:

nachricht Dengue takes low and slow approach to replication
12.01.2018 | Duke University

nachricht Fast food makes the immune system more aggressive in the long term
12.01.2018 | Rheinische Friedrich-Wilhelms-Universität Bonn

All articles from Health and Medicine >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: The first precise measurement of a single molecule's effective charge

For the first time, scientists have precisely measured the effective electrical charge of a single molecule in solution. This fundamental insight of an SNSF Professor could also pave the way for future medical diagnostics.

Electrical charge is one of the key properties that allows molecules to interact. Life itself depends on this phenomenon: many biological processes involve...

Im Focus: Paradigm shift in Paris: Encouraging an holistic view of laser machining

At the JEC World Composite Show in Paris in March 2018, the Fraunhofer Institute for Laser Technology ILT will be focusing on the latest trends and innovations in laser machining of composites. Among other things, researchers at the booth shared with the Aachen Center for Integrative Lightweight Production (AZL) will demonstrate how lasers can be used for joining, structuring, cutting and drilling composite materials.

No other industry has attracted as much public attention to composite materials as the automotive industry, which along with the aerospace industry is a driver...

Im Focus: Room-temperature multiferroic thin films and their properties

Scientists at Tokyo Institute of Technology (Tokyo Tech) and Tohoku University have developed high-quality GFO epitaxial films and systematically investigated their ferroelectric and ferromagnetic properties. They also demonstrated the room-temperature magnetocapacitance effects of these GFO thin films.

Multiferroic materials show magnetically driven ferroelectricity. They are attracting increasing attention because of their fascinating properties such as...

Im Focus: A thermometer for the oceans

Measurement of noble gases in Antarctic ice cores

The oceans are the largest global heat reservoir. As a result of man-made global warming, the temperature in the global climate system increases; around 90% of...

Im Focus: Autoimmune Reaction Successfully Halted in Early Stage Islet Autoimmunity

Scientists at Helmholtz Zentrum München have discovered a mechanism that amplifies the autoimmune reaction in an early stage of pancreatic islet autoimmunity prior to the progression to clinical type 1 diabetes. If the researchers blocked the corresponding molecules, the immune system was significantly less active. The study was conducted under the auspices of the German Center for Diabetes Research (DZD) and was published in the journal ‘Science Translational Medicine’.

Type 1 diabetes is the most common metabolic disease in childhood and adolescence. In this disease, the body's own immune system attacks and destroys the...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

Fachtagung analytica conference 2018

15.01.2018 | Event News

10th International Symposium: “Advanced Battery Power – Kraftwerk Batterie” Münster, 10-11 April 2018

08.01.2018 | Event News

See, understand and experience the work of the future

11.12.2017 | Event News

 
Latest News

Black hole spin cranks-up radio volume

15.01.2018 | Physics and Astronomy

A matter of mobility: multidisciplinary paper suggests new strategy for drug discovery

15.01.2018 | Life Sciences

New method to map miniature brain circuits

15.01.2018 | Life Sciences

VideoLinks
B2B-VideoLinks
More VideoLinks >>>