Document Type : Research articles
Authors
- Ali Ashraf Mozafari 1
- Mohammad Ali Mansournia 2
- Kourosh Sayehmiri 3
- Bahareh Ghiasi 4
- Mehdi Yaseri 2
- Golnaz Azami 5
1 Department of Epidemiology and Biostatistics, Tehran University of Medical Science, Tehran, Iran
2 Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
3 3. Departments of Community Medicine, Faculty of Medicine, Ilam University of Medical Sciences, Ilam, Iran
4 Department of Nephrology, School of Medicine, Ilam University of Medical Sciences, Ilam, Iran
5 Faculty of Nursing and Midwifery, Ilam University of Medical Sciences, Ilam, Iran
Abstract
Background: Lipid disorders are a well-documented risk factor for chronic kidney disease (CKD), but the impact of lipid abnormal- ities in the progression of the disease remains mixed.
Objectives: The current study aimed to extend the existing knowledge about the effect of lipid disorders in disease progression from moderate to severe stage using Flexible parametric survival models.
Methods: This retrospective cohort study included 308 moderate CKD patients who received the nephrologist follow-up visits at the nephrology clinic, Ilam (Iran), from 2012 to 2019. The survival time was determined based on the time medically diagnosed with moderate stages (GFR = 59 - 55 mL/min per 1.73 m2) to the time of progression to the severe stage (GFR = 29 - 25 mL/min per 1.73 m2) hazard using flexible parametric survival models.
Results: In univariate analysis, high levels of TG, LDL, and cholesterol were important risk factors which affect the CKD progression. The hazard of patients with TG > 200 mg/dL was 1.69 times higher than patients with desirable TG levels (P = 0.09). Moreover, for patients with LDL > 160 mg/dL, the hazard was 2.12 times higher than patients with desirable LDL levels (P = 0.01). The hazard of patients with total cholesterol levels > 240 mg/dL was 2.10 times higher than patients with desirable cholesterol levels (P = 0.003). The adjusted model was shown to better fit the PH model. Cholesterol levels > 240 mg/dL remains a significant risk factor for CKD progression (P = 0.03).
Conclusions: Effective treatment programs should pay closer attention to screening and treatment of hyperlipidemia in patients diagnosed with moderate CKD.
Keywords
- Tannock L. Dyslipidemia in chronic kidney disease. Endotext [Internet]. MDText. com, Inc; 2018.
- Hosseinpanah F, Kasraei F, Nassiri AA, Azizi F. High prevalence of chronic kidney disease in Iran: a large population-based study. BMC public Health. 2009;9(1):44.
- Alasker H, Alharkan S, Alharkan W, Zaki A, Riza LS. Detection of kidney disease using various intelligent classifiers. 2017 3rd International Conference on Science in Information Technology (ICSITech). IEEE; 2017. p. 681-4.
- Khwaja A, El Kossi M, Floege J, El Nahas M. The management of CKD: a look into the future. Kidney international. 2007;72(11):1316-23.
- Bouya S, Balouchi A, Rafiemanesh H, Hesaraki M. Prevalence of Chronic Kidney Disease in Iranian General Population: A Meta‐Analysis and Systematic Review. Therapeutic apheresis and dialysis. 2018;22(6):594-9.
- Hunsicker LG, Adler S, Caggiula A, England BK, Greene T, Kusek JW, et al. Predictors of the progression of renal disease in the Modification of Diet in Renal Disease Study. Kidney international. 1997;51(6):1908-19.
- Syrjänen J, Mustonen J, Pasternack A. Hypertriglyceridaemia and hyperuricaemia are risk factors for progression of IgA nephropathy. Nephrology Dialysis Transplantation. 2000;15(1):34-42.
- Mänttäri M, Tiula E, Alikoski T, Manninen V. Effects of hypertension and dyslipidemia on the decline in renal function. Hypertension. 1995;26(4):670-5.
- Muntner P, Coresh J, Smith JC, Eckfeldt J, Klag MJ. Plasma lipids and risk of developing renal dysfunction: the atherosclerosis risk in communities study. Kidney international. 2000;58(1):293-301.
- Schaeffner ES, Kurth T, Curhan GC, Glynn RJ, Rexrode KM, Baigent C, et al. Cholesterol and the risk of renal dysfunction in apparently healthy men. Journal of the American Society of Nephrology. 2003;14(8):2084-91.
- Fox CS, Larson MG, Leip EP, Culleton B, Wilson PW, Levy D. Predictors of new-onset kidney disease in a community-based population. Jama. 2004;291(7):844-50.
- Palmer SC, Craig JC, Navaneethan SD, Tonelli M, Pellegrini F, Strippoli GF. Benefits and harms of statin therapy for persons with chronic kidney disease: a systematic review and meta-analysis. Annals of internal medicine. 2012;157(4):263.
- Zare A, Hosseini M, Mahmoodi M, Mohammad K, Zeraati H, Naieni KH. A Comparison between accelerated failure-time and cox proportional hazard models in analyzing the survival of gastric cancer patients. Iranian journal of public health. 2015;44(8):1095.
- Royston P, Parmar MK. Flexible parametric proportional‐hazards and proportional‐odds models for censored survival data, with application to prognostic modelling and estimation of treatment effects. Statistics in medicine. 2002;21(15):2175-97.
- Royston P, Lambert PC. Flexible parametric survival analysis using Stata: beyond the Cox model. College Station, Texas: Stata Press Publication; 2011.
- Tutkun A, Yeldan M, Ilhan H. Flexible parametric survival models: An application to gastric cancer data. Int J Adv Appl Sci. 2017;4(1):91-5.
- Ramezani Tehrani F, Mansournia MA, Solaymani-Dodaran M, Steyerberg E, Azizi F. Flexible parametric survival models built on age-specific antimüllerian hormone percentiles are better predictors of menopause. Menopause. 2016;23(6):676-81.
- Mikolasevic I, Žutelija M, Mavrinac V, Orlic L. Dyslipidemia in patients with chronic kidney disease: etiology and management. International journal of nephrology and renovascular disease. 2017;10:35.
- Chen S, Hung C, Kuo M, Lee J, Chiu Y, Chang J, et al. Association of dyslipidemia with renal outcomes in chronic kidney disease. PLoS One. 2013;8(2). e55643.
- Lambert PC, Royston P. Further development of flexible parametric models for survival analysis. The Stata Journal. 2009;9(2):265-90.
- Visconti L, Benvenga S, Lacquaniti A, Cernaro V, Bruzzese A, Conti G, et al. Lipid disorders in patients with renal failure: role in cardiovascular events and progression of chronic kidney disease. Journal of clinical & translational endocrinology. 2016;6:8-14.
- Cases A, Coll E. Dyslipidemia and the progression of renal disease in chronic renal failure patients. Kidney International. 2005;68:S87-93.
- Bulbul MC, Dagel T, Afsar B, Ulusu NN, Kuwabara M, Covic A, et al. Disorders of lipid metabolism in chronic kidney disease. Blood purification. 2018;46(2):144-52.
- Samuelsson O, Mulec H, Knight-Gibson C, Attman PO, Kron B, Larsson R, et al. Lipoprotein abnormalities are associated with increased rate of progression of human chronic renal insufficiency. Nephrology, Dialysis, Transplantation: Official Publication Of The European Dialysis And Transplant Association-European Renal Association. 1997;12(9):1908-15.
- Pandya V, Rao A, Chaudhary K. Lipid abnormalities in kidney disease and management strategies. World journal of nephrology. 2015;4(1):83.
- Hager MR, Narla AD, Tannock LR. Dyslipidemia in patients with chronic kidney disease. Reviews in Endocrine and Metabolic Disorders. 2017;18(1):29-40.
- Khatiwada S, Rajendra KC, Gautam S, Lamsal M, Baral N. Thyroid dysfunction and dyslipidemia in chronic kidney disease patients. BMC endocrine disorders. 2015;15(1):65.
- Kronenberg F. HDL in CKD—The Devil Is in the Detail. Journal of the American Society of Nephrology. 2018;29(5):1356-71. doi: 10.1681/asn.2017070798.
- Krolewski AS, Warram JH, Christlieb AR. Hypercholesterolemia--a determinant of renal function loss and deaths in IDDM patients with nephropathy. Kidney International Supplement. 1994;(45).
- Ravid M, Brosh D, Ravid-Safran D, Levy Z, Rachmani R. Main risk factors for nephropathy in type 2 diabetes mellitus are plasma cholesterol levels, mean blood pressure, and hyperglycemia. Archives of internal medicine. 1998;158(9):998-1004.
- Jabarpour M, Rashtchizadeh N, Ghorbani Haghjo A, Argani H, Nemati M, Dastmalchi S, et al. Protection of renal damage by HMG-CoA inhibitors: A comparative study between atorvastatin and rosuvastatin. Iranian Journal of Basic Medical Sciences. 2019.
- Vaziri ND. Dyslipidemia of chronic renal failure: the nature, mechanisms, and potential consequences. American Journal of Physiology-Renal Physiology. 2006;290(2):F262-72.
- Bianchi S, Bigazzi R, Caiazza A, Campese VM. A controlled, prospective study of the effects of atorvastatin on proteinuria and progression of kidney disease. American journal of kidney diseases. 2003;41(3):565-70.
- Tonelli M, Collins D, Robins S, Bloomfield H, Curhan GC. Effect of gemfibrozil on change in renal function in men with moderate chronic renal insufficiency and coronary disease. American journal of kidney diseases. 2004;44(5):832-9.
', './data/ircmj/coversheet/cover_en.jpg'))