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

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-alpha (TNF-alpha) (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 (beta-coefficient = 0.569; P < 0.001) and inversely correlated with TNF-alpha (beta-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.