FRIDAY, Sept. 24 (HealthDay News) -- Malnutrition and
inflammation may be important risk factors for cardiovascular
disease in patients with chronic kidney disease (CKD) and need to
be considered when doctors are assessing patients' cholesterol
levels, a new study suggests.
Cardiovascular disease is a common condition and cause of death
in CKD patients. In the general population, high cholesterol levels
increase the risk of cardiovascular disease and death, but this
association isn't so clear in CKD patients, according to background
information in an American Society of Nephrology news release about
Previous research has shown that CKD patients with high
cholesterol levels are less likely to die than those with lower
cholesterol levels. This may be because high cholesterol levels in
these patients can indicate lower levels of malnutrition and
inflammation, two related complications of kidney disease.
The new study examined 990 black Americans with chronic kidney
disease who were not yet on dialysis. Malnutrition and/or
inflammation was present in 31 percent of the patients.
Over 12 years of follow-up, 20 percent of the patients
experienced a new cardiovascular disease "event" such as heart
attack, stroke, congestive heart failure, or death from heart
disease. The rates were similar among patients with and without
malnutrition and/or inflammation, 19 percent and 21 percent,
Among patients with malnutrition and/or inflammation, high
cholesterol levels were not associated with cardiovascular disease
events. But among patients without malnutrition and/or
inflammation, the risk of a new cardiovascular disease event
increased as cholesterol levels rose, the investigators found. The
risk was 2.18 times greater for those with cholesterol levels of
240 mg/dL or higher and 1.19 times greater for those with
cholesterol levels between 200 and 239 mg/dL, compared to those
with cholesterol levels less than 200 mg/dL.
"In CKD patients, the inconsistent and often inverse relationship of cholesterol level with cardiovascular disease and overall mortality may be explained by the presence of malnutrition and/or inflammation," study author Dr. Gabriel Contreras, of the University of Miami Miller School of Medicine, said in the news release.
This means physicians should investigate the causes of low and
high cholesterol levels in patients with chronic kidney disease,
the study authors noted.
"Whereas traditional risk factors such as elevated blood cholesterol levels remain important, they appear to compete and interact with non-traditional risk factors such as malnutrition and inflammation. Doctors caring for CKD patients should take into account the presence of malnutrition and inflammation as they interpret blood cholesterol levels," Contreras concluded.
The study findings were released online Sept. 23 in advance of
publication in an upcoming print issue of the
Journal of the American Society of Nephrology.
The American Academy of Family Physicians has more about
chronic kidney disease.