249129 Reverse epidemiological trends with aging end-stage renal disease patients

Monday, October 31, 2011

Rodney G. Bowden, PhD , School of Education, Baylor University, Waco, TX
Ronald L. Wilson, MD , Central Texas Nephrology Associates, Waco, TX
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.

Learning Areas:
Chronic disease management and prevention

Learning Objectives:
1. Describe the term reverse epidemiology as it relates to an aging and malnourished population 2. Analyze the differences in cholesterol values with ESRD patients who survived and did not survive during the three year study

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am the PI for this study
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.