ASSOCIATION OF ATHEROGENIC INDEX OF PLASMA WITH MORTALITY IN END-STAGE RENAL DISEASE PATIENTS: A CROSS-COUNTRY COMPARATIVE ANALYSIS

 

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https://storage.unitedwebnetwork.com/files/1099/fc2128409063c63fe3d1dbfa1d12a32e.pdf
ASSOCIATION OF ATHEROGENIC INDEX OF PLASMA WITH MORTALITY IN END-STAGE RENAL DISEASE PATIENTS: A CROSS-COUNTRY COMPARATIVE ANALYSIS

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Bengt
Lindholm
Zhimin Chen zhiminchen@zju.edu.cn Hangzhou University Kidney Disease Center Hangzhou China -
Abdul Rashid Qureshi tony.qureshi@ki.se Karolinska Institutet Renal Medicine Stockholm Sweden -
Kakei Ryu ryu-k@med.showa-u.ac.jp Showa Medical University Research Administration Center Tokyo Japan -
Mohamed E Suliman mohamed.saeid.suliman@ki.se Karolinska Institutet Renal Medicine Stockholm Sweden -
Peter Barany peter.barany@ki.se Karolinska Institutet Renal Medicine Stockholm Sweden -
Olof Heimburger olof.heimburger@ki.se Karolinska Institutet Renal Medicine Stockholm Sweden -
Peter Stenvinkel peter.stenvinkel@ki.se Karolinska Institutet Renal Medicine Stockholm Sweden -
Fei Han hanf8876@163.com Hangzhou University Kidney Disease Center Hangzhou China -
Hong Jiang annie.jh@vip.163.com Hangzhou University Kidney Disease Center Hangzhou China -
Jianghua Chen chenjianghua@zju.edu.cn Hangzhou University Kidney Disease Center Hangzhou China -
Rending Wang rd_wangjia@zju.edu.cn Hangzhou University Kidney Disease Center Hangzhou China -
Bengt Lindholm bengt.lindholm@ki.se Karolinska Institutet Renal Medicine Stockholm Sweden *
 
 
 

Prognostic implications of the atherogenic index of plasma (AIP), i.e. the logarithmically transformed ratio of plasma triglycerides (TG) to high-density lipoprotein-cholesterol (HDL), a biomarker of dyslipidemia and cardiovascular disease (CVD) risk in the general population, may differ between cohorts of end-stage renal disease (ESRD) patients. We examined associations between AIP and mortality in Chinese and Swedish cohorts of ESRD patients.

In 2471 Chinese peritoneal dialysis (PD) patients and 762 Swedish ESRD patients (comprising 121 patients receiving living donor kidney transplant, 471 non-dialyzed ESRD patients and 170 prevalent hemodialysis patients), baseline AIP and other biomarkers were analyzed in relation to all-cause and cardiovascular mortality risk during 5-years follow-up using competing-risk regression models with renal transplantation as a competing risk.

In 2471 Chinese patients, during median follow-up of 2.3 years, 11.3% died (40.1% due to cardiovascular mortality); 506 (20.5%) underwent renal transplantation. In 762 Swedish patients with median follow-up of 2.8 years, 31.5% died (50.4% of deaths were due to cardiovascular mortality); 243 (31.9%) underwent renal transplantation. 

A comparison between the two cohorts revealed - besides differences in treatment modality, ethnicity and geographical context - significant baseline differences as regards age, comorbidities, and clinical and laboratory characteristics. Swedish patients were older, had higher proportion of men, higher prevalence of cardiovascular disease, lower albumin levels, and higher levels of BMI, TG, cholesterol, HDL, and hsCRP than Chinese patients. However, AIP did not differ significantly. In Chinese incident PD patients: the association between AIP and mortality was significant with subdistribution hazard ratios (sHR) of 1.14 (95% CI 1.00-1.29, p=0.045) for all-cause mortality and 1.27 (95% CI 1.05-1.54, p=0.014) for cardiovascular mortality. Fine-Gray analysis, with renal transplantation as a competing risk, demonstrated that the cumulative incident risk of all-cause mortality was significantly higher in the high AIP group (AIP>0.3) compared to the low AIP group after adjustments. In Swedish ESRD patients: the association between AIP and mortality was not statistically significant. 

When analyzing the association between mortality and the components of AIP, triglycerides (TG) and high-density lipoprotein (HDL), high TG associated with increased risk of all-cause and cardiovascular mortality in the Chinese cohort, whereas high HDL associated with increased risk of cardiovascular mortality in the Swedish cohort. These associations persisted across most subgroups.

AIP associated with increased all-cause and cardiovascular mortality risk in Chinese incident PD patients but not in Swedish ESRD patients, confirming that the impact of AIP and its lipid components, TG and HDL, on mortality risk in ESRD is context dependent.

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