Lipids should be lowered for dialysis patients
Patients with end-stage renal disease should receive aggressive treatment to control cholesterol levels, despite there being an inverse association between higher cholesterol levels and mortality in this patient population, researchers suggest (JAMA 2004;291:451).
Dr Yongmei Liu, of Johns Hopkins University, Baltimore, Maryland, and
colleagues point out that prospective studies have consistently shown
that for dialysis patients overall mortality risk is lower at higher
total serum cholesterol levels. This paradoxical association has dampened
enthusiasm for treatment of hypercholesterolaemia in patients receiving
dialysis, they add.
However, in a detailed examination of patient lipid and inflammation
profiles, the researchers have shown that only patients showing evidence
of inflammation and malnutrition displayed the unexpected association
between higher cholesterol and lower mortality. “In the absence
of inflammation/malnutrition, the association was in the opposite direction,
with higher total cholesterol level associated with higher mortality,” say
the researchers.
They explain that some patients with end-stage renal disease who have
low serum cholesterol levels are at high risk of mortality because they
are in an inflammatory or malnourished state that itself lowers cholesterol
levels and increases risk of death.
“Not taking into account the effect of inflammation may lead to
an incorrect conclusion that high cholesterol is not harmful in end-stage
renal disease
patients and a failure to control cholesterol levels as aggressively
as in the general population,” they say. |
The
Pharmaceutical Journal