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April 21, 2004

Inflammation, Cholesterol Levels, and Risk of Mortality Among Patients Receiving Dialysis—Reply

Author Affiliations

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2004;291(15):1833-1834. doi:10.1001/jama.291.15.1834-b

In Reply: Dr Ravnskov and Drs Kalantar-Zadeh and Anker argue that high cholesterol levels may confer protection against infection and circulating lipopolysaccharides (ie, bacterial endotoxin) and that hypercholesterolemia should not be treated among patients receiving dialysis. Ravnskov cites the protective effects of dietary cholesterol supplementation in children with Smith-Lemli-Opitz syndrome, in whom cholesterol levels are extremely low (approximately 8-62 mg/dL [0.21-1.61 mmol/L]), as well as epidemiologic findings that low total cholesterol levels (<160 mg/dL [4.14 mmol/L]) are inversely associated with risk of infection. The latter associations in older individuals (>55 years) or patients with chronic disease could result from reverse causation. Frailty and subclinical disease can exist decades prior to a clinical event.