タカハシ　リナ   TAKAHASHI Rina   高橋　利奈    所属   医学部 医学科（東京女子医科大学病院）    職種   助教
言語種別	英語
発表タイトル	Revisiting the Lipid Paradox in Nondialysis-Dependent CKD and Mediation Effect of BMI on the Association of LDL Cholesterol and All-Cause Mortality
会議名	Kidney Week 2025
主催者	American Society of Nephrology
学会区分	国際学会及び海外の学会
発表形式	ポスター掲示
講演区分	一般
発表者・共同発表者	◎Takahashi, Rina, Tran Diana, Cohen-Hagai Keren, Rhee Connie, Sumida Keiichi, Kovesdy Csaba P, Kalantar-Zadeh Kamyar,
発表年月日	2025/11/06
国名	アメリカ合衆国
開催地 （都市, 国名）	Houston, USA
開催期間	2025/11/05～2025/11/09
概要	Background There are mixed reports on the lipid paradox in CKD, including whether a reverse association truly exists between LDL-C and mortality. The mortality risk associated with LDL-C may be confounded or mediated by factors such as BMI. We hypothesized that the observed lipid paradox in CKD might be mediated by BMI, given the obesity paradox. Methods In a national TRI-CKD cohort of 30,559 U.S. veterans with incident CKD (2004-2018), defined as two outpatient eGFR <60 mL/min/1.73m2, ≥90 days apart, both ≥25% below baseline. Patients were categorized into five LDL-C groups: <70, 70–<100, 100–<130, 130–<160, and ≥160 mg/dL. Cox proportional hazards models examined the association between LDL-C and mortality with progressive adjustment for demographics, comorbidities, labs including eGFR, and medications. Mediation analysis assessed the role of BMI. Results Patients with higher LDL-C tended to be younger (71.5 to 64.3), while mean eGFR remained stable (52.5 to 55.1 mL/min/1.73m2). LDL-C was weakly but significantly associated with BMI (β = –0.11, p = 0.001), but the effect size was negligible (R2 = 0.0003). LDL-C showed an inverse linear association with mortality in unadjusted models, consistent with the lipid paradox. With progressive adjustment, the association became U-shaped in the fully adjusted model. Mediation analysis showed no significant mediation effect of BMI (β_indirect < 0.01). Conclusion In this large national cohort of U.S. veterans with incident CKD, LDL-C exhibited a U-shaped association with all-cause mortality after comprehensive adjustment for potential confounders. Although LDL-C was modestly correlated with BMI, mediation analysis indicated no significant mediation effect of BMI on the LDL–mortality relationship. These findings suggest that the lipid paradox in CKD is not explained by the obesity paradox, and that LDL-C may instead be independently associated with mortality, specifically in non-dialysis CKD.