Palabras clave
Enfermedad renal crónica
dislipidemia
triglicéridos
lipoproteína de alta densidad
tasa de filtración glomerular
incidencia
asociación
enfermedad cardiovascular
cohorte
Colombia
dislipidemia
triglicéridos
lipoproteína de alta densidad
tasa de filtración glomerular
incidencia
asociación
enfermedad cardiovascular
cohorte
Colombia
Cómo citar
Becerra-Arias, C., Vera-Cala, L. M., & Fernández-Niño, J. A. (2019). Asociación entre la razón Tg/HDL y la Enfermedad Renal Crónica en una cohorte colombiana. Salud UIS, 51(4), 321–331. https://doi.org/10.18273/revsal.v51n4-2019005
Resumen
Introducción: La Enfermedad Renal Crónica (ERC) supone un fuerte impacto en la salud pública mundial. Esto es debido al elevado riesgo de enfermedad cardiovascular que presentan quienes la padecen. La razón triglicéridos/ lipoproteína de alta densidad se ha asociado con el desarrollo y progresión de la enfermedad renal. Objetivo: Estimar la asociación entre la razón triglicéridos/lipoproteína de alta densidad y la incidencia de enfermedad renal en una cohorte colombiana. Metodología: Estudio de cohorte prospectiva del seguimiento de INEFAC 2007-2017, con 1626 participantes. Para determinar la exposición principal se tomó como punto de corte >3,75 en la razón. Los casos se definieron con una tasa de filtración glomerular estimada <60ml/min/1,73m2 o con diagnóstico médico previo. Se ajustaron modelos de regresión lineal y log-binomial para los cambios en la tasa estimada y la incidencia de enfermedad renal crónica. Como covariables: edad, sexo, raza, alcohol, cigarrillo, circunferencia de cintura y actividad física. Resultados: La incidencia de enfermedad renal fue de 0,4% (IC 95% 0,1-0,8), el promedio de la tasa estimada de 94,3 ml/min/1,73m2. La asociación entre la razón triglicéridos/lipoproteína de alta densidad y la enfermedad renal crónica no fue estadísticamente significativa en el modelo crudo (RR= 2,3; IC 95%: 0,5-9,4) ni en el ajustado por confusores (RR= 1,1; IC 95%: 0,2–5,6). Conclusión: A partir del modelo múltiple no fue posible determinar la asociación, probablemente porque ésta no existe en la población estudiada o porque se requiere una alta muestra debido al bajo número de eventos encontrados.
Referencias
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3. Tsimihodimos V, Mitrogianni Z, Elisaf M. Dyslipidemia associated with chronic kidney disease. Open Cardiovasc Med J. 2011; 5(Vldl): 41-48. doi: http://dx.doi.org/doi:10.2174/187419240110501 0041.
4. Sarnak MJ, Levey AS, Schoolwerth AC, Coresh J, Culleton B, Hamm LL, et al. Kidney disease as a risk factor for development of cardiovascular disease: a statement from the American Heart Association Councils on kidney in cardiovascular disease, high blood pressure research, clinical cardiology, and epidemiology and prevention. Circ Cardiovasc Interv. 2003; 108: 2154-2169. doi: http://dx.doi. org/doi:10.1161/01.CIR.0000095676.90936.80.
5. Thomas R, Kanso A, Sedor JR. Chronic kidney disease and its complications. Prim Care. 2008; 35(2): 329-344. doi: http://dx.doi.org/doi:10.1016/j.pop.2008.01.008.
6. Jha V, Garcia-Garcia G, Iseki K, Li Z, Naicker S, Plattner B, et al. Chronic kidney disease: global dimension and perspectives. Lancet. 2013; 382(13): 260-272. doi: http://dx.doi.org/doi:10.1016/S0140-6736(13)60687-X.
7. Cuenta de Alto Costo. Boletín de información técnica especializada. 2018.
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9. Wang F, Ye P, Luo L, Xiao W, Wu H. Association of risk factors for cardiovascular disease and glomerular filtration rate: a community-based study of 4925 adults in Beijing. Nephrol Dial Transplant. 2010; 25: 3924-3931. doi: http://dx.doi.org/doi:10.1093/ndt/gfq327.
10. Tsuruya K, Yoshida H, Nagata M, Kitazono T, Hirakata H, Iseki K, et al. Association of the triglycerides to high-density lipoprotein cholesterol ratio with the risk of chronic kidney disease: analysis in a large Japanese population. Atherosclerosis. Elsevier Ltd. 2014; 233(1): 260–267. doi: http://dx.doi.org/doi:10.1016/j. atherosclerosis.2013.12.037
11. Hou X, Wang C, Zhang X, Zhao X, Wang Y, Li C, et al. Triglyceride levels are closely associated with mild declines in estimated glomerular filtration rates in middle-aged and elderly Chinese with normal serum lipid levels. PLoS One. 2014; 9(9): e106778. doi: http:// dx.doi.org/doi:10.1371/journal.pone.0106778.
12. Muntner P, Coresh J, Smith C, Eckfeldt J, Klag M. Plasma lipids and risk of developing renal dysfunction: The atherosclerosis risk in communities study. Kidney Int Suppl. 2000; 58: 293-301.
13. De Boer IH, Astor BC, Kramer H, Palmas W, Seliger SL, Shlipak MG, et al. Lipoprotein abnormalities associated with mild impairment of kidney function in the multi-ethnic study of atherosclerosis. Clin J Am Soc Nephrol. 2008; 3(1): 125-132. doi: http://dx.doi.org/doi:10.2215/CJN.03390807.
14. Chan CM. Hyperlipidaemia in chronic kidney disease. Ann Acad Med Singapore. 2005; 34(1): 31-35.
15. Vaziri ND. Dyslipidemia of chronic renal failure: the nature, mechanisms, and potential consequences. Am J Physiol Renal Physiol. 2019; 290(2): F262-F272. doi: https://doi.org/10.1152/ ajprenal.00099.2005.
16. Lodh M, Lal S, Goswami B, Karmakar P, Parida AK. Dyslipidemia in chronic renal failure: ¿Cause or effect? Asian J Med Sci. 2016; 7(5): 42-46. doi: http://dx.doi.org/doi:10.3126/ajms.v7i5.14755.
17. Tsuruya K, Kitazono T, Yoshida H, Iseki K, Nagata M, Iseki C, et al. Impact of the triglycerides to high-density lipoprotein cholesterol ratio on the incidence and progression of CKD: a longitudinal study in a large Japanese population. Am J Kidney Dis. 2015; 66(6): 972-983. doi: http://dx.doi.org/doi:10.1053/j.ajkd.2015.05.011.
18. Sonmez A, Yilmaz MI, Saglam M, Unal HU, Hakki MG, Karaman C, et al. The role of plasma triglyceride/high-density lipoprotein cholesterol ratio to predict cardiovascular outcomes in chronic kidney disease. Lipids in Health and Disease. 2015; 14:29. doi: https://doi.org/10.1186/s12944-015-0031-4.
19. Mänttäri M, Tiula E, Alikoski T, Manninen V. Effects of hypertension and dyslipidemia on the decline in renal function. Hypertension.1995; 26: 670-675. doi: http://dx.doi.org/doi:10.1161/01. HYP.26.4.670.
20. Aljabri KS, Bokhari SA, Alshareef MA, Khan PM, AbuElsaoud HM, Jalal MM, et al. Serum lipid profiles in patients with chronic kidney disease in a Saudi population. Endocrinol Metab Int J. 2019; 7(1): 41-46.
21. Bautista LE, Orostegui M, Vera LM, Prada GE, Orozco LC, Herrán OF. Prevalence and impact of cardiovascular risk factors in Bucaramanga, Colombia: results from the Countrywide Integrated Noncommunicable Disease Intervention Programme (CINDI / CARMEN) baseline survey. Eur J Cardiovasc Prev Rehabil. 2006; 13: 769-775.
22. Fukuyama N, Homma K, Wakana N, Kudo K, Suyama A, Ohazama H, et al. Validation of the Friedewald equation for evaluation of plasma LDL-Cholesterol. J Clin Biochem Nutr. 2008; 43(1): 1-5. doi: http://dx.doi.org/doi:10.3164/ jcbn.2008036.
23. American academy of family physicians. practice guidelines: New AHA Recommendations for blood pressure measurement - FP Essent. 2005.
24. Martínez A, Górriz JL, Bover J, Segura-de la Morena J, Cebollada J, Escalada J, et al. Documento de consenso para la detección y manejo de la enfermedad renal crónica. Atención Prim. 2014; 46(9): 501-519. doi: http://dx.doi.org/doi:10.1016/j.aprim.2014.09.002.
25. National Institutes of Health. third report of the national cholesterol education program. detection, evaluation and treatment of high blood cholesterol in adults (adults treatment panel III). 1991; 151(6): 1-284.
26. Kang HT, Shim JY, Lee YJ, Lee JE, Linton JA, Kim JK, et al. Association between the ratio of triglycerides to high-density lipoprotein cholesterol and chronic kidney disease in Korean adults: the 2005 Korean National Health and Nutrition Examination Survey. Kidney Blood Press Res. 2011; 34(3): 173-179. doi: http://dx.doi. org/doi:10.1159/000323895.
27. Kim JY, Kang HT, Lee HR, Lee YJ, Shim JY. Comparison of lipid-related ratios for prediction of chronic kidney disease stage 3 or more in korean adults. J Korean Med Sci. 2012; 27(12): 1524-1529. doi: http://dx.doi.org/10.3346/jkms.2012.27.12.1524.
28. Sauer B, Brookhart MA, Roy JA, VanderWeele TJ. Covariate Selection. In: Velentgas P, Dreyer NA, Nourjah P, Smith ST, Marion M. Torchia editors. Developing a protocol for observational comparative effectiveness research: a user´s guide. Rockville: agency for healthcare research and quality; 2013.p. 1-32.
29. Wang F, Zheng J, Ye P, Luo L, Bai Y, Xu R, et al. Association of High-Density lipoprotein cholesterol with the estimated glomerular filtration rate in a community-based population. Plos One. 2013; 8(11): e79738. doi: http://dx.doi.org/doi:10.1371/journal.pone.0079738.
30. Ji B, Zhang S, Gong L, Wang Z, Ren W, Li Q, et al. The risk factors of mild decline in estimated glomerular filtration rate in a community-based population. Clin Biochem. 2013; 46: 750-754. doi: http://dx.doi.org/10.1016/j. clinbiochem.2013.01.011.
31. Yang T, Chu CH, Hsu CH, Hsieh PC, Chung TC, Bay CH, et al. Impact of metabolic syndrome on the incidence of chronic kidney disease: A Chinese cohort study. Nephrology. 2012; 17: 532- 538. doi: http://dx.doi.org/doi:10.1111/j.1440- 1797.2012.01607.x.
32. Vargas-Uricoechea H, Casas-Figueroa LA. Epidemiología de la diabetes mellitus en Sudamérica: la experiencia de Colombia. Clin Investig Arterioscler. 2016; 28(5): 245-256. doi: http://dx.doi.org/10.1016/j.arteri.2015.12.002.
33. Ramachandran A, Snehalatha C, Shetty AS, Nanditha A. Trends in prevalence of diabetes in Asian countries. World J Diabetes. 2012; 3(6): 110-117. doi: http://dx.doi.org/doi:10.4239/wjd. v3.i6.110.
34. Liu Y, Zhou D, Zhang Z, Song Y, Zhang D, Zhao T, et al. Effects of genetic variants on lipid parameters and dyslipidemia in a Chinese population. J Lipid Res. 2011; 52(2): 354-360. doi: http://dx.doi.org/ doi:10.1194/jlr.P007476.
35. Peralta CA, Shlipak MG, Fan D, Ordoñez J,Lash JP, Chertow GM, et al. Risks for end-stage renal disease, cardiovascular events, and death in Hispanic versus Non-Hispanic white adults with chronic kidney disease. J Am Soc Nephrol. 2006; 17: 2892-2899. doi: http://dx.doi.org/doi:10.1681/ ASN.2005101122.
36. Fernández-Niño J. Comentario editorial. La importancia de publicar estudios con resultados “negativos”. Rev Univ Ind Santander Salud. 2016; 48(4): 467-468.
37. Bosques PF, Gómez AD. El sesgo de publicación es un problema científico frecuente que tiene consecuencias éticas adversas [editorial]. Medicina Universitaria. 2009;11(42): 1-2.
2. Cusumano AM, González BM. Chronic kidney disease in Latin America: Time to improve screening and detection. Clin J Am Soc Nephrol. 2008; 3(2): 594-600. doi: http://dx.doi.org/doi:10.2215/CJN.03420807.
3. Tsimihodimos V, Mitrogianni Z, Elisaf M. Dyslipidemia associated with chronic kidney disease. Open Cardiovasc Med J. 2011; 5(Vldl): 41-48. doi: http://dx.doi.org/doi:10.2174/187419240110501 0041.
4. Sarnak MJ, Levey AS, Schoolwerth AC, Coresh J, Culleton B, Hamm LL, et al. Kidney disease as a risk factor for development of cardiovascular disease: a statement from the American Heart Association Councils on kidney in cardiovascular disease, high blood pressure research, clinical cardiology, and epidemiology and prevention. Circ Cardiovasc Interv. 2003; 108: 2154-2169. doi: http://dx.doi. org/doi:10.1161/01.CIR.0000095676.90936.80.
5. Thomas R, Kanso A, Sedor JR. Chronic kidney disease and its complications. Prim Care. 2008; 35(2): 329-344. doi: http://dx.doi.org/doi:10.1016/j.pop.2008.01.008.
6. Jha V, Garcia-Garcia G, Iseki K, Li Z, Naicker S, Plattner B, et al. Chronic kidney disease: global dimension and perspectives. Lancet. 2013; 382(13): 260-272. doi: http://dx.doi.org/doi:10.1016/S0140-6736(13)60687-X.
7. Cuenta de Alto Costo. Boletín de información técnica especializada. 2018.
8. Fondo colombiano de enfermedades de alto costo. Situación de la enfermedad renal en Colombia 2015.
9. Wang F, Ye P, Luo L, Xiao W, Wu H. Association of risk factors for cardiovascular disease and glomerular filtration rate: a community-based study of 4925 adults in Beijing. Nephrol Dial Transplant. 2010; 25: 3924-3931. doi: http://dx.doi.org/doi:10.1093/ndt/gfq327.
10. Tsuruya K, Yoshida H, Nagata M, Kitazono T, Hirakata H, Iseki K, et al. Association of the triglycerides to high-density lipoprotein cholesterol ratio with the risk of chronic kidney disease: analysis in a large Japanese population. Atherosclerosis. Elsevier Ltd. 2014; 233(1): 260–267. doi: http://dx.doi.org/doi:10.1016/j. atherosclerosis.2013.12.037
11. Hou X, Wang C, Zhang X, Zhao X, Wang Y, Li C, et al. Triglyceride levels are closely associated with mild declines in estimated glomerular filtration rates in middle-aged and elderly Chinese with normal serum lipid levels. PLoS One. 2014; 9(9): e106778. doi: http:// dx.doi.org/doi:10.1371/journal.pone.0106778.
12. Muntner P, Coresh J, Smith C, Eckfeldt J, Klag M. Plasma lipids and risk of developing renal dysfunction: The atherosclerosis risk in communities study. Kidney Int Suppl. 2000; 58: 293-301.
13. De Boer IH, Astor BC, Kramer H, Palmas W, Seliger SL, Shlipak MG, et al. Lipoprotein abnormalities associated with mild impairment of kidney function in the multi-ethnic study of atherosclerosis. Clin J Am Soc Nephrol. 2008; 3(1): 125-132. doi: http://dx.doi.org/doi:10.2215/CJN.03390807.
14. Chan CM. Hyperlipidaemia in chronic kidney disease. Ann Acad Med Singapore. 2005; 34(1): 31-35.
15. Vaziri ND. Dyslipidemia of chronic renal failure: the nature, mechanisms, and potential consequences. Am J Physiol Renal Physiol. 2019; 290(2): F262-F272. doi: https://doi.org/10.1152/ ajprenal.00099.2005.
16. Lodh M, Lal S, Goswami B, Karmakar P, Parida AK. Dyslipidemia in chronic renal failure: ¿Cause or effect? Asian J Med Sci. 2016; 7(5): 42-46. doi: http://dx.doi.org/doi:10.3126/ajms.v7i5.14755.
17. Tsuruya K, Kitazono T, Yoshida H, Iseki K, Nagata M, Iseki C, et al. Impact of the triglycerides to high-density lipoprotein cholesterol ratio on the incidence and progression of CKD: a longitudinal study in a large Japanese population. Am J Kidney Dis. 2015; 66(6): 972-983. doi: http://dx.doi.org/doi:10.1053/j.ajkd.2015.05.011.
18. Sonmez A, Yilmaz MI, Saglam M, Unal HU, Hakki MG, Karaman C, et al. The role of plasma triglyceride/high-density lipoprotein cholesterol ratio to predict cardiovascular outcomes in chronic kidney disease. Lipids in Health and Disease. 2015; 14:29. doi: https://doi.org/10.1186/s12944-015-0031-4.
19. Mänttäri M, Tiula E, Alikoski T, Manninen V. Effects of hypertension and dyslipidemia on the decline in renal function. Hypertension.1995; 26: 670-675. doi: http://dx.doi.org/doi:10.1161/01. HYP.26.4.670.
20. Aljabri KS, Bokhari SA, Alshareef MA, Khan PM, AbuElsaoud HM, Jalal MM, et al. Serum lipid profiles in patients with chronic kidney disease in a Saudi population. Endocrinol Metab Int J. 2019; 7(1): 41-46.
21. Bautista LE, Orostegui M, Vera LM, Prada GE, Orozco LC, Herrán OF. Prevalence and impact of cardiovascular risk factors in Bucaramanga, Colombia: results from the Countrywide Integrated Noncommunicable Disease Intervention Programme (CINDI / CARMEN) baseline survey. Eur J Cardiovasc Prev Rehabil. 2006; 13: 769-775.
22. Fukuyama N, Homma K, Wakana N, Kudo K, Suyama A, Ohazama H, et al. Validation of the Friedewald equation for evaluation of plasma LDL-Cholesterol. J Clin Biochem Nutr. 2008; 43(1): 1-5. doi: http://dx.doi.org/doi:10.3164/ jcbn.2008036.
23. American academy of family physicians. practice guidelines: New AHA Recommendations for blood pressure measurement - FP Essent. 2005.
24. Martínez A, Górriz JL, Bover J, Segura-de la Morena J, Cebollada J, Escalada J, et al. Documento de consenso para la detección y manejo de la enfermedad renal crónica. Atención Prim. 2014; 46(9): 501-519. doi: http://dx.doi.org/doi:10.1016/j.aprim.2014.09.002.
25. National Institutes of Health. third report of the national cholesterol education program. detection, evaluation and treatment of high blood cholesterol in adults (adults treatment panel III). 1991; 151(6): 1-284.
26. Kang HT, Shim JY, Lee YJ, Lee JE, Linton JA, Kim JK, et al. Association between the ratio of triglycerides to high-density lipoprotein cholesterol and chronic kidney disease in Korean adults: the 2005 Korean National Health and Nutrition Examination Survey. Kidney Blood Press Res. 2011; 34(3): 173-179. doi: http://dx.doi. org/doi:10.1159/000323895.
27. Kim JY, Kang HT, Lee HR, Lee YJ, Shim JY. Comparison of lipid-related ratios for prediction of chronic kidney disease stage 3 or more in korean adults. J Korean Med Sci. 2012; 27(12): 1524-1529. doi: http://dx.doi.org/10.3346/jkms.2012.27.12.1524.
28. Sauer B, Brookhart MA, Roy JA, VanderWeele TJ. Covariate Selection. In: Velentgas P, Dreyer NA, Nourjah P, Smith ST, Marion M. Torchia editors. Developing a protocol for observational comparative effectiveness research: a user´s guide. Rockville: agency for healthcare research and quality; 2013.p. 1-32.
29. Wang F, Zheng J, Ye P, Luo L, Bai Y, Xu R, et al. Association of High-Density lipoprotein cholesterol with the estimated glomerular filtration rate in a community-based population. Plos One. 2013; 8(11): e79738. doi: http://dx.doi.org/doi:10.1371/journal.pone.0079738.
30. Ji B, Zhang S, Gong L, Wang Z, Ren W, Li Q, et al. The risk factors of mild decline in estimated glomerular filtration rate in a community-based population. Clin Biochem. 2013; 46: 750-754. doi: http://dx.doi.org/10.1016/j. clinbiochem.2013.01.011.
31. Yang T, Chu CH, Hsu CH, Hsieh PC, Chung TC, Bay CH, et al. Impact of metabolic syndrome on the incidence of chronic kidney disease: A Chinese cohort study. Nephrology. 2012; 17: 532- 538. doi: http://dx.doi.org/doi:10.1111/j.1440- 1797.2012.01607.x.
32. Vargas-Uricoechea H, Casas-Figueroa LA. Epidemiología de la diabetes mellitus en Sudamérica: la experiencia de Colombia. Clin Investig Arterioscler. 2016; 28(5): 245-256. doi: http://dx.doi.org/10.1016/j.arteri.2015.12.002.
33. Ramachandran A, Snehalatha C, Shetty AS, Nanditha A. Trends in prevalence of diabetes in Asian countries. World J Diabetes. 2012; 3(6): 110-117. doi: http://dx.doi.org/doi:10.4239/wjd. v3.i6.110.
34. Liu Y, Zhou D, Zhang Z, Song Y, Zhang D, Zhao T, et al. Effects of genetic variants on lipid parameters and dyslipidemia in a Chinese population. J Lipid Res. 2011; 52(2): 354-360. doi: http://dx.doi.org/ doi:10.1194/jlr.P007476.
35. Peralta CA, Shlipak MG, Fan D, Ordoñez J,Lash JP, Chertow GM, et al. Risks for end-stage renal disease, cardiovascular events, and death in Hispanic versus Non-Hispanic white adults with chronic kidney disease. J Am Soc Nephrol. 2006; 17: 2892-2899. doi: http://dx.doi.org/doi:10.1681/ ASN.2005101122.
36. Fernández-Niño J. Comentario editorial. La importancia de publicar estudios con resultados “negativos”. Rev Univ Ind Santander Salud. 2016; 48(4): 467-468.
37. Bosques PF, Gómez AD. El sesgo de publicación es un problema científico frecuente que tiene consecuencias éticas adversas [editorial]. Medicina Universitaria. 2009;11(42): 1-2.
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