Association between remnant cholesterol and chronic kidney disease: Systematic review and meta-analysis

Adequate lipid control has emerged as a key factor in the prevention and management of chronic kidney disease (CKD). Remnant cholesterol (RC), a lipoprotein with an established association with cardiovascular risk, has been investigated in the context of CKD. Given the conflicting results from recent studies, we performed this meta-analysis to summarize the existing evidence on the association between RC and CKD.

Medline, Cochrane Library and Scopus were searched until 16 September 2024. Double-independent study selection, data extraction and quality assessment were performed. Evidence was pooled using random-effects meta-analyses. We set as primary end-point of interest the association between RC and CKD.

Twelve studies (4 139 674 participants) were included. Participants with RC values in the highest quantile had significantly greater odds of CKD compared to those in the lowest quantile (Odds Ratio [OR] = 1.46, 95% confidence interval [CI] = 1.26-1.68). In a sensitivity analysis confined to subjects with type 2 diabetes (T2D), those in the higher RC quantile also exhibited significantly increased odds of CKD compared to those in the lowest quantile (OR = 1.46, 95% CI = 1.20-1.78). A significant inverse association was observed between RC and estimated glomerular filtration rate (Mean Difference [MD] = -1.43 mL/min/1.73 m² for each 1 mmol/L increase in RC, 95% CI = [-2.67, -0.19]). Additionally, individuals with T2D-related CKD had a 24% increased risk of progression to end-stage renal disease for each 1 standard deviation increase in RC (Hazard Ratio [HR] = 1.24, 95% CI = 1.04-1.47).

RC is directly associated with higher risk for CKD. Beyond traditional lipid markers, greater emphasis should be placed on RC levels in individuals with or at risk for CKD.