Cholesterol No Benefit for Those on Dialysis
Further research disproves belief that high levels offered protection
 (HealthDayNews) -- It was a paradox doctors could not explain: People on dialysis with high cholesterol levels appeared to have a lower risk of death.
But the reason this counterintuitive finding could not be explained, contended researchers from Johns Hopkins Bloomberg School of Public Health, was that it just was not true.
In a study first published last year in the Journal of the American Medical Association, the researchers explained that some people with kidney disease may have low levels of cholesterol but be at increased risk of dying because their cholesterol levels are decreased by malnutrition and inflammation -- two common conditions in people on dialysis.
"Higher cholesterol is associated with a lower risk of mortality and cardiovascular risk in dialysis patients," the study's author, Dr. Josef Coresh, an associate professor of epidemiology, medicine and biostatistics, told HealthDay. But, Coresh said, the researchers believed that other factors were masking the actual risk that high cholesterol posed in these people.
Once the researchers took inflammation and malnutrition into account, people on dialysis with high cholesterol levels had a 30 percent increased risk of mortality, the study reported.
The findings suggest that by lowering their cholesterol, people on dialysis might also reduce their risk of death, Coresh said.
Currently, about 275,000 Americans are on dialysis, according to the National Kidney Foundation. In dialysis, a machine filters and pulls toxins out of the blood when the kidneys can no longer perform that function.
Cardiovascular disease is widespread among people on dialysis. In fact, the study reported that half of all people on dialysis actually will die from cardiovascular disease.
Over a three-year period, the researchers collected information on 823 people, with an average age of 57, from 79 centers across the United States. All had recently started undergoing dialysis.
Blood samples were taken to look for inflammation and determine nutritional status. People undergoing dialysis have special nutritional needs, according to the National Kidney Foundation. Weight loss is a common concern.
When the researchers compared cholesterol levels to mortality, Coresh said, it appeared that higher cholesterol had a protective effect. But, when inflammation and malnutrition were factored in, the protective effect of high cholesterol vanished. Instead, high cholesterol was associated with a 30 percent increase in overall mortality and a 41 percent jump in cardiovascular death.
"That patients with high cholesterol had lower mortality and cardiovascular risk was always peculiar," Dr. David Goldfarb, director of dialysis at the New York VA Hospital, told HealthDay. "The study added to the evidence that "having high cholesterol is not a good thing," he said.
But, he said, it's too soon to know if lowering cholesterol in this group of people will help lower their risk of heart disease. And, because the medications have not been studied in people on dialysis, it also is not clear whether cholesterol-lowering medications would be of benefit.
On the Web
The National Institute of Diabetes & Digestive & Kidney Diseases offers information on proper nutrition for people receiving dialysis.
SOURCES:
Author: Serena Gordon
HealthDay News; Josef Coresh, M.D., Ph.D., associate professor of epidemiology, medicine and biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore; David Goldfarb, M.D., director of dialysis, New York VA Hospital, and associate professor of medicine and physiology, New York University School of Medicine, New York City; Jan. 28, 2004, Journal of the American Medical Association; National Kidney Foundation, New York City
Publication Date: Jan. 31, 2005
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