MP648ACHIEVEMENT RATIO OF SERUM LIPID MANAGEMENT GOALS IN LONG-TERM CHRONIC HEMODIALYSIS PATIENTS FOR 0VER 30 YEARS

Abstract

Introduction and Aims: Chronic hemodialysis (HD) patients usually have lower plasma high-density lipoprotein (HDL)-cholesterol (C) levels than healthy subjects. Low HDL-C levels are associated with an increased risk of death in chronic HD patients. Categorization for patients with dyslipidemia has been proposed in Japanese Atherosclerosis Society Guideline for prevention of Atherosclerotic Cadiovascular Disease 2012. Achievement ratio of serum lipid management goals (SLMGs) in chronic HD patients is unclear. Clinical practice guideline for chronic kidney disease-mineral and bone disorder (CKD-MBD) has been proposed by the Japanese Society for Dialysis Therapy. The aim of this study is to investigate the achievement ratio of SLMGs and CKD-MBD in long-term chronic hemodialysis patients. Methods: We retrospectively investigated the serum total cholesterol (TC), triglyceride (TG), low-density lipoprotein (LDL)-C, HDL-C, phosphate (P), calcium (Ca), intact parathyroid hormone (intact-PTH), β2-microglobulin (β2-M), high sensitive CRP, serum albumin levels in 98 chronic HD patients (55 females and 43 males, mean age: 65.2±6.1 years, mean HD duration: 406.7±31.4 months). Results: The mean TC value in 98 HD patients was 163.7±35.7 mg/dL, the mean TG value was 102.2±50.4 mg/dL. The mean HDL-C value was 58.1±14.6 mg/dL, the mean LDL-C value was 89.2±28.3 mg/dL. The mean P value was 5.2±1.2 mg/dL, the mean Ca value was 9.0±0.9 mg/dL. The mean intact-PTH value was 168.5±211.8 pg/dL, the meanβ2-M value was 24.8±6.3 mg/L. The mean CRP value was 1.1±2.6 mg/dL, the mean albumin value was 3.6±0.4 g/dL. SLMGs of LDL-C levels are below 120 mg/dL and achievement ratio of LDL-C was 85.7 % (84 HD patients). SLMGs of HDL-C levels are over 40 mg/dL, achievement ratio of HDL-C was 94.9 % (94 HD patients). Management goals of P levels are 3.5∼6.0 mg/dL and achievement ratio of P was 74.5 % (73 HD patients). Management goals of Ca levels are 8.4∼10.0 mg/dL and achievement ratio of Ca levels was 71.4 % (70 HD patients). Management goals of intact-PTH levels are 60∼240 pg/mL and achievement ratio of intact-PTH levels was 57.1 % (56 HD patients). Management goals of β2-M are below 30 mg/L and achievement ratio of β2-M levels was 81.6 % (80 HD patients). Case: A 67-year-old woman presented tongue disease and renal failure. She started HD three times a week due to chronic glomerulonephritis in May 1973. She gave birth to a boy in June 1977. Dialysis amyloidosis plus positive HCV (HCV-Ab: 14.27 s/co) was accompanied with hypoalbuminemia. Her serum albumin was 3.1 g/dL and total protein was 8.7 g/dL. Her Hb was 10.4 g/dL, her serum creatinine was 8.17 mg/dL, Ca was 8.9 mg/dL and P was 5.5 mg/dL in October 2015. Her intact-PTH was 5 pg/mL, alkaline phosphatase (ALP) was 239 U/L and bone specific alkaline phosphatase (BAP) was 14.8μg/L. Her serum TC was 179 mg/dL, TG was 62 mg/dL, HDL-C was 61 mg/dL, LDL-C was 104 mg/dL and remnant like particles-cholesterol (RLP-C) was 3.4 mg/dL. Her serum apolipoprotein A-I(apo A-I) was 146 mg/dL, apo A-II was 29.0 mg/dL, apo B was 80 mg/dL, apo C-II was 1.9 mg/dL, apo C-III was 9.3 mg/dL and apo E was 5.4 mg/dL. Her serumβ2-M was 19.7 mg/L and serum amyloid A protein was 85.5μg/mL. Her serum zinc was 61μg/dL and Kt/V was 1.76. She could walk on her own, and on her feet for a long time. It has been reported that serum HDL-C and exercise are related. Conclusions: Achievement ratio of HDL-C in long-term chronic HD patients was high. HDL-C may be a survival factor in long-term chronic HD patients.