Nonfasting Non–High-Density Lipoprotein Cholesterol Is Adequate for Lipid Management in Hemodialysis Patients Simon Desmeules, MD, Jean-François Arcand-Bossé, MD, Jean Bergeron, MD, Pierre Douville, MD, and Mohsen Agharazii, MD ● Background: Guidelines for the management of dyslipidemia in patients with chronic kidney disease are based on results from the fasting lipid profile, which can be difficult to obtain from patients on an afternoon or night dialysis schedule. The present study tests the hypothesis that nonfasting non– high-density lipoprotein (HDL) cholesterol (total cholesterol–HDL cholesterol) results are similar to fasting non-HDL results as a basis for the management of dyslipidemia in hemodialysis patients. Methods: Forty-eight long-term hemodialysis patients with a mean age of 63.6 years (42% with diabetes, 54% administered statins) participated in this study. For the lipid profile, blood samples were drawn after a 12-hour overnight fast (fasting) and again in a nonfasting state before the subsequent hemodialysis session. Data were analyzed by using paired t-test and regression analysis. Results: Non-HDL cholesterol values were nearly identical regardless of whether the patient was fasting (r 2  0.995). Only 2 patients (4%) had a nonfasting triglyceride (TG) level greater than 500 mg/dL (>5.6 mmol/L), which would have required confirmation after an overnight fast. Non-HDL values had the greatest level of correlation (absolute relative difference, 5.7%). When comparing the subgroup of patients with a TG level less than 200 mg/dL (<2.3 mmol/L), nonfasting non-HDL cholesterol values identified 3 additional patients compared with fasting calculated low- density lipoprotein cholesterol for whom lipid-lowering therapy would have been introduced according to current guidelines. Conclusion: In our study, non-HDL cholesterol levels were equivalent whether evaluated in the fasting or nonfasting state. We recommend that nonfasting non-HDL cholesterol level be used for the management of dyslipidemia in hemodialysis patients without imposing a 12-hour fast period. Am J Kidney Dis 45:1067-1072. © 2005 by the National Kidney Foundation, Inc. INDEX WORDS: Hemodialysis (HD); lipid profile; nonfasting; fasting; dyslipidemia; non– high-density lipoprotein (HDL) cholesterol. T HE CARDIOVASCULAR mortality rate is 20 times greater in patients with chronic kidney disease than in the general population. 1 In an attempt to reduce the burden of cardiovascu- lar disease in patients with chronic kidney dis- ease, aggressive management of cardiovascular risk factors has been proposed. Qualitative and quantitative modifications of the uremic lipid profile may be responsible in part for the inverse relation observed between total cholesterol (TC) level and mortality in the end-stage renal disease population. 2 Hemodialysis patients usually have “normal” TC and low-density lipoprotein (LDL) cholesterol levels, whereas they have a tendency toward lower high-density lipoprotein (HDL) cholesterol and higher triglyceride (TG) levels. 3 This lipid profile is described as atherogenic dyslipidemia in the general population. Recently, guidelines for the management of patients with dyslipidemia and chronic kidney disease have been published. 4 Algorithms are based on results from the fasting lipid profile, which can be more difficult to obtain from pa- tients with diabetes and patients with an after- noon or night dialysis schedule. Apolipoprotein B100 (ApoB) concentrations are not affected by meals; however, these measurements are expen- sive and not readily available in most clinical centers. Non-HDL cholesterol represents the sum of LDL, intermediate-density lipoprotein (IDL), and very LDL cholesterol levels and correlates highly with ApoB level. Therefore, it has been sug- gested that non-HDL cholesterol level may be a better marker of “atherogenic cholesterol” than LDL cholesterol level. 5 Non-HDL cholesterol can be calculated easily by subtracting HDL from TC (non-HDL = TC – HDL). In the general population, non-HDL cholesterol level is at least as powerful a predictor of cardiovascular disease From the Services of Nephrology and Biochemistry, De- partment of Medicine, Centre Hospitalier Universitaire de Québec-Hôtel-Dieu de Québec, 11, Côte du Palais, Québec, Canada. Received December 28, 2004; accepted in revised form March 8, 2005. Originally published online as doi:10.1053/j.ajkd.2005.03.002 on April 19, 2005. Address reprint requests to Simon Desmeules, MD, Ser- vice of Nephrology, CHUQ-Hôtel-Dieu de Québec, 11, Côte du Palais, Quebec City, QC G1R 2J6, Canada. E-mail: simon.desmeules@mail.chuq.qc.ca © 2005 by the National Kidney Foundation, Inc. 0272-6386/05/4506-0012$30.00/0 doi:10.1053/j.ajkd.2005.03.002 American Journal of Kidney Diseases, Vol 45, No 6 (June), 2005: pp 1067-1072 1067