Eleonora Assanto (1), Antonietta Gigante (1), Giulia Gammaitoni (1), Paolo Nardozi (1), Martina Del Vecchio (1), Ottavio Martellucci (1), Carlotta Ciarniello (1), Alberto Palladini (1), Maurizio Muscaritoli (1), Rosario Cianci (1)

(1) Università degli studi di Roma La Sapienza

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Background: chronic kidney disease (CKD) is associated with dyslipidaemia, including high triglycerides (TG), low HDL-cholesterol and altered lipoprotein composition. Cardiovascular diseases are the leading cause of death in CKD, especially in end stage renal disease (ESRD) patients. Recent epidemiologic data demonstrating the association between elevations in serum TG and cardiovascular disease, using lower (89mg/dL) than conventional (150mg/dL) prognostic cut-off value of TG for cardiovascular events.

Aim: to evaluate if TG levels >89 and >150 mg/dl mg/dl equally predict worse clinical outcomes in CKD hospitalized patients.Methods: we retrospectively analyzed medical records of consecutive CKD patients admitted to our Internal Medicine ward. Information including clinical features, comorbidities, in-hospital complications and (causes of) death were collected. Worse clinical outcomes incorporated all-cause of in-hospital mortality and occurrence of new cardiovascular and infectious complications. 
We considered TG >89 mg/dl as a cut-off value, according to the most recent studies. We used the t-test or Mann–Whitney, according to normal or non-normal distribution, to evaluate differences between groups. Associations between categorical variables were assessed by Chi Square Test. A p value <0.05 was considered significant.

Results: we collected data of 122 inpatients with a mean age of 76.4 + 10.2 years; 79 females (6.8%), median serum creatinine 1.85 mg/dl (1.4-2.8), median estimated glomerular filtration rate (eGFR) of 33.6 ml/min (20.3-44.2). Eighty-six patients (70,5%) had TG levels > 89 mg/dL. In-hospital mortality was observed in 19 (15,6%) cases and 76 (62,3%) patients of our cohort developed worse clinical outcomes. Among the 86 patients with TG >89mg/dl, 53 (61,6%) showed TG between 90 and 150 mg/dl while in 33 (38,4%) of them TG were >150mg/dl.Patients with TG between 90-150 mg/dl had median serum creatinine of 2mg/dl (1,5-2,8) and median eGFR of 28,3 ml/min (20,1-38,8). Worse clinical outcomes and mortality were observed in 32 (60,4%) and 6 (11,3%) patients, respectively. Patients with TG >150 mg/dl had median serum creatinine of 2,4 mg/dl (1,7-3,5) and median eGFR of 24,5 ml/min (15,5-40,6). Worse clinical outcomes and mortality were observed in 21 (63,6%) and 9 (27,3%) patients, respectively. As expected, no significant difference was found between these two subgroups in clinical characteristics, worse clinical outcomes, and in-hospital mortality (p>0.05).

Conclusion: elevated TG levels are related to cardiovascular events and mortality.  In CKD patients, serum TG > 89mg/dL are associated with worse clinical outcomes and in-hospital mortality in a fashion similar to  TG >150mg/dL. Further studies are needed to confirm these findings and to ascertain whether the current cut-off value of 150 mg dL should be reduced to 89 mg dL to predict negative outcomes even in non-ESRD CKD patients.