AbstractBackgroundPatients with end‐stage kidney disease have an extremely high cardiovascular mortality rate, but there is a paradoxical relationship between lipid profile and survival in haemodialysis patients. To investigate whether inflammation/malnutrition confounds the associations between lipids and mortality, we studied a full lipid profile comprising of five clinically well‐established lipid parameters and its associations with mortality in a large, multinational European cohort with a median follow‐up >3 years.MethodsThe association between quartiles of total, high‐density lipoprotein (HDL), non‐HDL, low‐density lipoprotein (LDL) cholesterol, as well as triglyceride, levels and the end‐points of all‐cause, cardiovascular and non‐cardiovascular mortality was assessed in a cohort of 5,382 incident, adult haemodialysis patients from >250 Fresenius Medical Care dialysis centres out of 14 participating countries using baseline and time‐dependent Cox models. Analyses were fully adjusted and stratified for inflammation/malnutrition status and other patient‐level variables.ResultsTime‐dependent quartiles of total, HDL, non‐HDL and LDL cholesterol were inversely associated with the hazard for all‐cause, cardiovascular and non‐cardiovascular mortality. Compared with the lowest quartile of the respective lipid parameter, hazard ratios of other quartiles were <0.86. Similar, albeit weaker, associations were found with baseline lipid profile and mortality. Neither time‐dependent nor baseline associations between lipid profile and mortality were affected by inflammation/malnutrition, statin use or geography.ConclusionsBaseline and time‐dependent lipid profile are inversely associated with mortality in a large, multicentre cohort of incident haemodialysis patients. Inflammation/malnutrition is not a confounder nor effect modificator of the associations between lipid profile and mortality in European haemodialysis patients.