Reverse epidemiological trends with End-Stage Renal Disease patients

Introduction: A number of traditional risk factors, including cholesterol levels, for cardiovascular disease (CVD) demonstrate an inverse relationship with mortality among dialysis patients. These findings are antithetical to epidemiological conclusions in other populations and have been called reverse epidemiology. Research is being conducted to see if this effect is attributable to a malnutrition–inflammation complex syndrome or a multifaceted interaction of dialysis and mortality. Therefore the purpose of this study was to examine the differences in lipid levels in End-Stage Renal Disease (ESRD) patients who survived or died during a three year period. Methods: A study of End-Stage Renal Disease patients (N=437) was conducted over a three year period with a mortality rate of 18.3% during the study. Results: ANOVA revealed a significant difference in total cholesterol (p=.017), LDL particle number (p=.001), and triglycerides (p=.032) with the survivor group having significantly higher levels. HDL, LDL, LDL particle size and VLDL were not significantly different. Conclusions: Our study demonstrated a reverse epidemiology effect in total cholesterol, LDL particle number, and triglycerides. Though yet to be well established, public health and medical interventions with ESRD patients that can improve inflammation levels and nutritional status may help to improve clinical outcomes independent of lipid values. Additionally, inflammation and malnutrition may be more associated with short-term rather than long-term survival; therefore improvements in these markers may help to improve mortality and morbidity. Annual mortality rates of 20% are standard in dialysis patients and the understanding of factors that contribute this mortality rate is warranted.