Remnant cholesterol and kidney disease progression in type 2 diabetes: A retrospective cohort study

Recent cohort studies demonstrated that higher levels of serum remnant cholesterol (remnant-C) were a predictor of kidney outcomes in diabetes; however, these studies did not take into account triglycerides, highly correlated with remnant-C.

This study aimed to elucidate whether serum remnant-C predicts kidney disease progression in people with diabetes when considering triglycerides.

This was a retrospective cohort study of 5214 adults with type 2 diabetes, classified into 4 groups by median of remnant-C and triglycerides levels. Exposures were remnant-C and triglycerides, defined as their geometric means within individuals at baseline and during the follow-up period. The outcome was a composite of a ≥40% decrease in estimated glomerular filtration rate or the initiation of kidney replacement therapy. Hazard ratios (95% CI) were estimated by the multivariable Fine-Gray model treating death as a competing risk.

During the median follow-up period of 8.8 years, 1070 people reached the outcome. Hazard ratios (vs people with both below-median remnant-C and triglycerides) for the outcome were 1.21 (0.88-1.65), 1.48 (1.07-2.05), and 1.33 (1.13-1.58) in those with only above-median triglycerides, only above-median remnant-C, and both above-median remnant-C and triglycerides, respectively. When classifying participants by quartile of remnant-C, outcome hazards gradually increased from the first to fourth quartile. The association for triglycerides was similar, but weaker. By adjusting for both 4-category dummy variables for remnant-C and triglycerides, the gradual increase was observed only in remnant-C.

Remnant-C can predict kidney disease progression in type 2 diabetes, even considering triglycerides.