Decreased high-density lipoprotein cholesterol is associated with inflammation and insulin resistance in non-diabetic haemodialysis patients

Abstract

Aim: Lower serum high-density lipoprotein cholesterol (HDL-C) is associated with inflammation, insulin resistance and poor cardiovascular outcomes in the general population. However, in a large-scale study, the association between HDL and survival in haemodialysis patients was not present. The exact cause of lack of HDL-C protection in the dialysis population is still obscure.

Methods: A total of 89 stable non-diabetic haemodialysis patients were recruited. Fasting serum biochemical parameters, complete blood counts and inflammatory markers were obtained before the mid-week dialysis. Insulin resistance was assessed by the Homeostasis Model Assessment of Insulin Resistance (HOMA-IR).

Results: The mean age was 58.2±13.1 years, 37 (41.6%) patients were male. The mean HDL-C level was 56.3±17.1 mg/dL. By bivariate correlation analysis, a lower serum HDL-C level was related to higher body mass index (r=-0.425; P<0.001), higher triglyceride (r=-0.479; P<0.001) and higher HOMA-IR (r=-0.211; P<0.05) levels. The serum HDL-C level was also inversely related to high-sensitivity C-reactive protein (hsCRP) (r=-0.297; P=0.005) and tumour necrosis factor-α (TNF-α) (r=-0.295; P=0.005) and directly correlated with adiponectin (r=0.560; P<0.001). In multivariate linear regression analysis, HDL-C was found to be directly correlated with adiponectin (β-coefficient=0.569; P<0.001) and inversely correlated with TNF-α (β-coefficient=-0.292; P=0.001).

Conclusion: A strong association between HDL-C, inflammatory surrogates, and insulin resistance in this non-diabetic, non-obese haemodialysis patient group is demonstrated. The HDL-C level is still a good parameter to screen high-risk patients.