Association of baseline and cumulative remnant cholesterol with incidence of diabetic nephropathy: A longitudinal cohort study

Wu, Zhiyuan; Yu, Siqi; Zhu, Qian; Li, Zhiwei; Zhang, Haiping; Kang, Xiaoping; Xu, Zongkai; Miao, Xinlei; Liu, Xiangtong; Li, Xia; Zhang, Jingbo; Wang, Wei; Tao, Lixin; Guo, Xiuhua

doi:10.1016/j.diabres.2022.110079

Cited by 9 publications

(7 citation statements)

References 39 publications

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“…Elevated RC levels were found as considerable proteinuria resulting from the progression of diabetic nephropathy, according to a study on 105 Japanese T2DM patients [ 32 ]. Wu et al found that high RC was independently associated with the development of diabetic nephropathy [ 16 ]. Studies have shown that RC can predict the onset of both type 1 and type 2 diabetic retinopathy [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

“…Some systematic evaluation studies have revealed an association between diabetic microangiopathy and common macrovascular complications [ 15 ]. Several recent studies have reported that RC is directly linked to the onset of diabetic nephropathy [ 16 ] and can predict how the condition will progress [ 17 ]. High remnant cholesterol is a potential risk factor for the development of retinopathy in patients with type 2 diabetes [ 18 ].…”

Section: Introductionmentioning

confidence: 99%

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High remnant cholesterol as a risk factor for developing chronic kidney disease in patients with prediabetes and type 2 diabetes: a cross-sectional study of a US population

Zhu,

Liu,

Liu

et al. 2024

Acta Diabetol

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Aims To examine any potential links between remnant cholesterol (RC) and comorbid chronic kidney disease (CKD) in individuals with prediabetes and type 2 diabetes mellitus (T2DM). Methods We used data from 2709 American people aged > 20 years from the National Health and Nutrition Examination Survey (NHANES) during 2011–2018. Subjects were categorized according to whether they had comorbid CKD. Logistic regression models and smoothed curve fitting methods were employed to assess the association of RC with comorbid CKD in patients with prediabetes and T2DM. Results The 2709 participants included 1473 patients with T2DM and 1236 with prediabetes [impaired glucose tolerance (IGT) and impaired fasting glucose (IFG)], of whom 744 (27.46%) had comorbid CKD. In multivariate-adjusted analysis, both RC and triglycerides (TG) were significantly associated with an increased risk of comorbid CKD, and a 1 mmol/L elevation of RC increased the risk by 38.1% [HR (95% CI) 1.636 (1.242, 2.156)], which was higher than the risk associated with a 1 mmol/L increase in TG [1.255 (1.106, 1.424)]. Additionally, those in the highest quartile of RC had a 43.6% higher risk of concomitant renal damage than those in the lowest quartile. RC was linearly and positively associated with the incidence of comorbid CKD in this population. Conclusions RC is an independent risk factor for comorbid CKD in patients with prediabetes and T2DM. This finding provides a novel insight into the management and early detection of renal disease in patients with impaired glucose metabolism.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

High remnant cholesterol as a risk factor for developing chronic kidney disease in patients with prediabetes and type 2 diabetes: a cross-sectional study of a US population

Zhu,

Liu,

Liu

et al. 2024

Acta Diabetol

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“…Moreover, in 395 individuals without DM, those with CKD exhibited a higher cholesterol content in VLDL and IDL—commonly referred to as remnant-C—while their cholesterol contents in LDL and HDL were lower than those in controls without CKD [ 19 ]. Several longitudinal studies have also found an increased risk for diabetic nephropathy increases with a higher baseline remnant-C levels; however, these were limited only to individuals with DM and were relatively small studies with 4000 to 5000 subjects [ 21 , 22 ]. Nevertheless, to date, there is insufficient supportive evidence to establish a clear relationship between remnant-C and the development of ESRD on a population basis.…”

Section: Discussionmentioning

confidence: 99%

“…This finding highlights the previously unrecognized significance of elevated remnant-C levels in assessing the risk for ESRD in the general population, and its importance is even more pronounced in individuals with a lower risk for kidney disease. A prospective study involving 4237 individuals with type 2 DM reported no difference in the risk for incident diabetic nephropathy associated with baseline and cumulative levels of remnant-C across risk factor subgroups, including age, sex, and fasting glucose levels [ 22 ]. On the other hand, this large study involving > 3.8 million participants was able to identify those with elevated levels of remnant-C who were at higher risk for developing ESRD.…”

Section: Discussionmentioning

confidence: 99%

“…Supporting these findings, a study including 5150 patients with type 1 DM followed for a median of 8 years found that a 1 standard deviation rise in remnant-C levels related to a 51% increased risk for progression of diabetic nephropathy, defined as worsening albumin excretion or renal replacement therapy [ 21 ]. Similarly, in a five-year follow-up of 4237 individuals with type 2 DM, an 82.3% higher risk for diabetic nephropathy was observed in the highest tertile compared with the lowest tertile of remnant-C levels [ 22 ]. However, based on available information, no study to date has longitudinally evaluated the role of remnant-C in the development of ESRD in a population-based cohort.…”

Section: Introductionmentioning

confidence: 99%

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High remnant-cholesterol levels increase the risk for end-stage renal disease: a nationwide, population-based, cohort study

Jung,

Huh,

Roh

et al. 2024

Lipids Health Dis

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Background The effect of remnant-cholesterol (remnant-C) on incident end-stage renal disease (ESRD) has not been studied longitudinally. This retrospective cohort study evaluated the association between remnant-C and the development of ESRD in a nationwide Korean cohort. Methods Participants in a National Health Insurance Service health examination (n = 3,856,985) were followed up until the onset of ESRD. The median duration of follow-up was 10.3 years. The Martin-Hopkins equation was used to determine low-density lipoprotein cholesterol (LDL-C) levels from directly measured triglyceride, high-density lipoprotein cholesterol (HDL-C), and total cholesterol levels. Remnant-C levels were determined by subtracting HDL-C and LDL-C from total cholesterol. The risk for incident ESRD was calculated for each quartile of remnant-C, adjusting for conventional risk factors such as baseline renal function, comorbidities, and total cholesterol levels. Results ESRD developed in 11,073 (0.29%) participants. The risk for ESRD exhibited a gradual increase according to higher levels of remnant-C, with a 61% increased risk in the highest quartile than in the lowest (hazard ratio [HR] 1.61 [95% confidence interval (CI) 1.50–1.72]). The elevated risk for ESRD in the highest quartile versus the lowest quartile was more prominent in younger than in older subjects (20–29 years, HR 4.07 [95% CI 2.85–5.83]; 30–39 years, HR 2.39 [95% CI 1.83–3.13]; ≥ 70 years, HR 1.32 [95% CI 1.16–1.51]). In addition, the increased risk for ESRD related to higher remnant-C levels was greater in females than in males. Conclusions Independent of conventional risk factors, remnant-C levels were positively associated with incident ESRD, particularly in younger populations and adult females. Reducing remnant-C levels may be a novel preventive strategy against ESRD.

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Remnant cholesterol and the risk of diabetic nephropathy progression to end-stage kidney disease in patients with type 2 diabetes mellitus: a longitudinal cohort study

Zhao,

Liu,

Zou

et al. 2024

Endocrine

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Aim Diabetic nephropathy (DN) is the most common cause of end-stage kidney disease (ESKD). Remnant cholesterol has been investigated as a predictor for the progression of DN in type 1 diabetes mellitus patients, as well as the incidence of DN in type 2 diabetes mellitus (T2DM) patients. This study aimed to evaluate the longitudinal relationship between baseline remnant cholesterol and kidney outcomes using a Chinese T2DM with biopsy-confirmed DN cohort. Methods We included 334 patients with T2DM and biopsy-confirmed DN during 2010–2019 West China Hospital T2DM-DN cohort. Remnant cholesterol was defined by Martin-Hopkins equation. Patients were divided into four groups based on the median (IQR) remnant cholesterol concentration at the time of renal biopsy. The kidney outcome was defined as ESKD, which was defined as the need for chronic kidney replacement therapy or estimated glomerular filtration rate (eGFR) < 15 mL/min/1.73 m2. The relationship between remnant cholesterol and kidney outcome was analyzed using the Kaplan‒Meier method and Cox regression analysis. Results The mean age was 51.1 years, and 235 (70%) were men. During follow-up, a total of 121 (36.2%) patients reached ESKD. The Kaplan‒Meier analysis showed that patients in the highest quartile (quartile 4) group had lower cumulative renal survival (log-rank test, p = 0.033) and shorter median renal survival time [34.0 (26.4–41.6) vs. 55.0 (29.8–80.2) months] than patients in the lowest quartile (quartile 1) group. By univariate analysis, the high remnant cholesterol group was associated with a higher risk of progression to ESKD. Moreover, the risk of progression to ESKD in the highest quartile was still 2.857-fold (95% CI 1.305–6.257, p = 0.009) higher than that in the lowest quartile, and one-SD increase of remnant cholesterol was associated with a higher risk (HR = 1.424; 95% CI 1.075–1.886, p = 0.014) of progression to ESKD, after adjusted for confounding factors. Conclusions High remnant cholesterol is independently associated with a higher risk of ESKD in patients with T2DM-DN, and it may be a new noninvasive marker of ESKD. Clinical relevance Calculated remnant cholesterol has the advantages of being economical and clinically accessible. Moreover, to our knowledge, there are no longitudinal cohort studies for investigating the risk of progression of T2DM-DN to ESKD. In our study, higher remnant cholesterol was associated with a higher risk of ESKD in patients with T2DM-DN, and it may be a new noninvasive predictor of ESKD.

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Association of baseline and cumulative remnant cholesterol with incidence of diabetic nephropathy: A longitudinal cohort study

Cited by 9 publications

References 39 publications

High remnant cholesterol as a risk factor for developing chronic kidney disease in patients with prediabetes and type 2 diabetes: a cross-sectional study of a US population

High remnant cholesterol as a risk factor for developing chronic kidney disease in patients with prediabetes and type 2 diabetes: a cross-sectional study of a US population

High remnant-cholesterol levels increase the risk for end-stage renal disease: a nationwide, population-based, cohort study

Remnant cholesterol and the risk of diabetic nephropathy progression to end-stage kidney disease in patients with type 2 diabetes mellitus: a longitudinal cohort study

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