| Background:The prevalence of chronic kidney disease（CKD）is high in both developing and developed countries,and it is demonstrating an increasing trend.It is generally believed that the concentrations of low-density lipoprotein cholesterol（LDL-C）and total cholesterol（TC）do not increase continuously in patients with CKD.Despite these general considerations,there is still controversy about the lipid profiles of patients with CKD at all stages.Arteriovenous fistula（AVF）is widely used among patients undergoing HD due to its low primary failure rate,incidence of infection,as well as its good reliability.KDIGO guidelines believe that the use of statins in HD patients does not improve cardiovascular outcomes,and therefore intensive lipid-lowering therapy is not recommended for HD patients,however,we should be aware that lipid-lowering therapy is not limited to improving cardiovascular outcomes,but it also helps prevent other complications caused by lipid metabolic disorders,such as AVF dysfunction.Therefore,we believe that a meta-analysis should be conducted to clarify the lipid profiles of CKD patients,and the lipid changes before and after the loss of AVF function.Objective:To explore the lipid profile of CKD patients and compare the lipid changes before and after the malfunctioning of arteriovenous fistula.Methods:We searched Pub Med,Web of Science,the China Science Periodical Database,Embase,the Cochrane library,CNKI,CBM,and the China Science and Technology Journal Database.The final search was conducted on August 31,2021,and the search period was restricted between 2000 and August 31,2021,without publication restrictions.All studies met the inclusion criteria,and the influence of sex,age,geographical location,diagnosis method,and publication year were excluded.We used the Newcastle–Ottawa Scale（NOS）to assess the quality of the studies.The patients with CKD were divided into three groups（CKD stages 1-2,CKD stages 3-4,and CKD stage 5）according to the clinical stages according to the KDIGO（kidney disease: improving global outcomes,KDIGO）guidelines,which compared the blood lipid levels of the patients with CKD and the healthy control groups.Differences in patients and healthy control subjects are expressed as mean difference（MD）with associated 95% confidence interval（CI）.Apply revman5.3 software for statistical analysis.The data were analyzed using the random effect model and fixed effect model.The overall effect was tested using the Z-score,and statistical significance was considered whenever the p value was under 0.05.Heterogeneity between studies was assessed using the Q test and I2 test provided by the software If heterogeneity was present（I2 ≥ 50%,P ≤ 0.1）,the random-effects model was used.If heterogeneity was absent（I2 < 50%,P > 0.1）（21）,the fixed-effects model was used.Publication bias was assessed using Eggers’ test.Results:（1）The search identified 157 articles,for which the full texts were examined.Totally,129 articles were excluded;thus,a total of 28 studies were included.All of the included studies were case–control studies.The 28 studies included a total of 121,666 patients with CKD and 390,415 healthy control subjects;thus,a total of 512,081 people were included in the analysis.Thirteen studies examined AVF failure and hyperlipidemia,and 15 articles examined CKD and healthy control subjects.（2）The levels of TC（MD: 6.97,95% CI: 2.19 – 11.74,P = 0.004）and LDL-C（MD:23.83,95% CI: 18.48 – 29.18,P < 0.00001）in AVF dysfunction group were higher than those in AVF patency group.The HDL-C level of AVF dysfunction was lower than that of AVF patency group（MD:-2.68,95% CI:-4.60 to-0.76,P = 0.006）.However,there was no significant difference in TG levels between the two groups（MD:-3.18,95%CI:-10.69 to 4.32,P = 0.41）.（3）Patients with CKD1-2 had higher levels of TG（MD: 0.08,95% CI: 0.04-0.11,P< 0.0001）,TC（MD: 0.32,95% CI: 0.28-0.37,P < 0.00001）,and LDL-C（MD: 0.11,95%CI: 0.07-0.14,P < 0.00001）than healthy controls and lower levels of HDL（MD:-0.08,95% CI:-0.12 to-0.04,P = 0.0002）.（4）Patients with CKD 3-4 had higher TG levels than healthy controls（MD: 0.35,95%CI: 0.27-0.43,P < 0.00001）.TC（MD:-0.14,95% CI:-0.23 to-0.04,P = 0.004）and HDL-C levels（MD:-0.03,95% CI:-0.04 to-0.02,P < 0.00001）were lower in patients with CKD3-4 than in healthy controls.There was no significant difference between the two groups in LDL-C levels（MD:-0.15,95% CI:-0.36 to 0.06,P = 0.16）.（5）The levels of TG were higher in CKD 5 patients than in healthy controls（MD:0.74,95% CI: 0.47 – 1.02,P < 0.00001）,whereas levels of TC（MD:-0.82,95% CI:-1.07 to-0.57,P < 0.00001）and HDL-C（MD:-0.31,95% CI:-0.35 to-0.26,P <0.00001）were lower in CKD 5 patients than in healthy controls.There was no significant difference in LDL-C between the two groups（MD:-0.27,95% CI:-0.67 to-0.13,P =0.19）.Conclusion:（1）Compared with the healthy control group,CKD1-5 patients were characterized by high TG and low HDL-C;The level of LDL-C was higher in patients with CKD1-2,but there was no significant difference in patients with CKD3-5;TC levels were higher in patients with CKD1-2 and lower in patients with CKD3-5.（2）The TC and LDL-C concentrations in the groups with AVF failure were significantly higher than in healthy controls with AVF patency.Although current guidelines do not consider intensive lipid-lowering therapy as necessary in patients undergoing HD,to prevent AVF failure,we believe that patients undergoing HD should be regularly treated with lipid-lowering therapy. |
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