Reverse epidemiological trends with aging 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 over 65. 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 or a multifaceted interaction of dialysis, age and mortality. Therefore the purpose of this study was to examine the differences in lipid levels in End-Stage Renal Disease (ESRD) patients over 65 with normal or low albumin levels. Methods: A study of End-Stage Renal Disease patients over 65 (N=149) was conducted over a three year period with a mortality rate of 18.3% during the study. Results: ANCOVA revealed a significant difference in LDL particle size (p=.0001), and LDL (p=.032) with the survivor group having significantly higher levels. HDL, LDL particle number and VLDL were not significantly different. Conclusions: Our study demonstrated a reverse epidemiology effect in LDL particle size and LDL in an aging population. Though yet to be well established, public health and medical interventions with aging ESRD patients that can improve nutritional status may help to improve clinical outcomes independent of lipid values. Additionally, 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.