| Objective:To investigate the effect of baseline plasma low density lipoprotein cholesterol level on long-term prognosis of patients with maintenance hemodialysis(MHD).Materials and Methods:From January 1,2010 to September 30,2016,hemodialysis patients who started and maintained hemodialysis in the hemodialysis center of Nephrology Department of our hospital were enrolled.They were over 18 years old,under 90 years old and the duration of dialysis was over 3 months.General data of age,sex,primary disease and complications were recorded.Baseline blood routine,liver function,renal function,total cholesterol,triglyceride,low density lipoprotein and high density lipoprotein were measured.Double reverse osmosis water and standard bicarbonate dialysis were used for 4 hours three times a week.The end point was all-cause death.Survival time is the time from dialysis to death.Deletion value is defined as the number of patients who are still alive or lost to visit until December 31,2016.The time record unit is month.The patients were divided into two groups according to baseline low density lipoprotein cholesterol level(LDL>1.8 mmol/L and LDL<1.8 mmol/L),and the difference of mortality between the two groups was analyzed.Measuring data are expressed by mean(+standard deviation),normal distribution data are compared by T test,and counting data are compared by Chi-square test.Kaplan-Meter analysis was used for survival analysis and log-rank test was used for survival comparison.Cox regression analysis was used to analyze the influence of age,sex,primary disease and baseline test on survival.SPSS 13.0 was used for statistical analysis,P<0.05 had statistical difference.Results:A total of 647 eligible patients were enrolled in the study,including 384 males and 263 females.The top three etiological categories were diabetes mellitus 41.3%(267 cases),glomerulonephritis 32.3%(209 cases),hypertension 16.2%(105 cases);coronary heart disease 82 cases(12.6%),peripheral vascular disease 63 cases(9.7%),stroke 78 cases(12.0%)and hypertension 571 cases(88.3%).333 cases(51.5%)were complicated with diabetes mellitus;the average age of starting dialysis was(57.0+14.9)years;the middle follow-up time was 21 months;155 patients died of all causes,including 109 cases of cardiovascular and cerebrovascular death,accounting for 70.3%.Other causes of death included tumors in 7 cases,infection in 3 cases,multiple organ failure in 2 cases,gastrointestinal bleeding in 1 case,intestinal rupture in 2 cases,and other 23 cases.471 patients with LDL(>1.8 mmol/L)in the first group,268 males and 203 females,died 122 cases,all-cause mortality rate was 25.9%,cardio-cerebrovascular death accounted for 70.5%.The average age of starting dialysis was57.6±14.6 years.The median follow-up time was 20 months.The survival rates of 1,2,3,4,5,6 and 7 years were 94%,81%,72%,63%,50%,42%and 34%,respectively;the second group was LDL<1.8 mmol/L patients.176 patients,116 males and 60 females,died in 33 cases,the all-cause mortality rate was 18.7%.Cardiovascular and cerebrovascular mortality accounted for 69.7%.The median follow-up time was 22 months.The 1-year,2-year,3-year,4-year,5-year,6-year and 7-year survival rates were 93%,83%,79%,74%,70%,63%,63%,respectively.The results of log-rank test showed that there was significant difference in survival rate between the two groups(x2=5.723,P = 0.017).The survival rate of the second group was significantly higher than that of the first group.Multivariate COX regression analysis showed that age at the beginning of dialysis,LDL cholesterol level,EF,coronary heart disease,stroke and diabetes were independent predictors of death(P<0.05).Conclusion:The baseline plasma LDL cholesterol level is closely related to the long-term prognosis of maintenance hemodialysis patients.The plasma LDL cholesterol level before dialysis should be one of the therapeutic targets.Age,EF,and complications were the independent risk factors for death in maintenance hemodialysis patients. |
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