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Declining eGFR and Uremia Are Associated with Remnant Cholesterol Accumulation and Reduced HDL-C in Non-Dialysis
Hanan Alyami1, Fahd A Alshuweishi2, Nadiah A Baghdadi3
1Department of Medical and Surgical Nursing, College of Nursing, Princess Norah Bint Abdurrahman University, Riyadh 11564, Saudi Arabia.
Insights
Lipid abnormalities like low HDL-C and high remnant cholesterol are common in chronic kidney disease (CKD). These lipid changes correlate with reduced kidney function and uremia, suggesting they reflect metabolic issues in CKD progression.
Area of Science:
- Nephrology
- Cardiovascular Medicine
- Clinical Chemistry
Background:
- Cardiovascular disease (CVD) risk is high in chronic kidney disease (CKD) patients, even with normal conventional lipid profiles.
- Lipid pattern variations across CKD stages and metabolic complications are not fully understood.
- This study investigates lipid patterns in relation to renal function and CKD metabolic complications.
Purpose of the Study:
- To evaluate lipid patterns in CKD patients.
- To determine associations between lipid parameters, estimated glomerular filtration rate (eGFR), and metabolic complications like uremia and hyperphosphatemia.
- To assess the potential of lipid profiles to reflect metabolic disturbances in CKD.
Main Methods:
- Retrospective cross-sectional study of 229 CKD patients.
- Data extraction included laboratory lipid parameters and clinical variables.
- Statistical analyses included nonparametric tests, multivariable regression, and ROC analysis, with stratification by KDIGO eGFR stage, uremia, and phosphate status.
Main Results:
- Low HDL-C (high-density lipoprotein cholesterol) and elevated remnant cholesterol (RC) were the most prevalent lipid abnormalities.
- Decreasing eGFR was associated with reduced HDL-C and increased RC.
- Both HDL-C and RC showed significant independent associations with eGFR and blood urea nitrogen (BUN), indicating their link to renal function and uremia.
Conclusions:
- Alterations in HDL-C and RC are independently associated with declining renal function and uremic status in CKD patients.
- Lipoprotein composition, specifically HDL-C and RC levels, may serve as indicators of metabolic disturbances in CKD progression.
- These findings highlight the importance of evaluating specific lipid components beyond standard lipid panels in managing CVD risk in CKD.
Abstract:
Background: Cardiovascular risk in chronic kidney disease (CKD) remains high despite frequently normal conventional lipid parameters. The extent to which lipid patterns vary across CKD severity and metabolic complications remains incompletely characterized. Therefore, this study evaluated lipid patterns and their associations with renal function and CKD-related metabolic complications. Methods: This retrospective cross-sectional study included 229 CKD patients from the nephrology clinic at King Saud Medical City. Single-time-point laboratory data and clinical variables were extracted from medical records. Patients were stratified by KDIGO eGFR stage, uremia, and phosphate status. Lipid parameters were analyzed using nonparametric tests, multivariable regression, and ROC analysis. Results: Among 229 CKD patients, the most prevalent lipid abnormalities were low HDL-C (49.8%) and elevated remnant cholesterol (RC) (31.4%). HDL-C was reduced and RC increased with declining eGFR, while TC, LDL-C, and TG remained unchanged. In uremia, HDL-C remained reduced and RC increased, with additional reductions in TC and LDL-C, whereas TG did not differ. No significant lipid changes were observed with hyperphosphatemia. In multivariable analyses, HDL-C was positively associated with eGFR (β = 48.8, q = 0.003) and inversely associated with BUN (β = -14.3, q = 0.0014), while RC showed an inverse association with eGFR (β = -19.9, q = 0.0005) and a positive association with BUN (β = 3.37, q = 0.0315). These relationships remained independent of age, sex, BMI, smoking status, hypertension, and type 2 diabetes. ROC analysis further demonstrated the moderate discriminatory ability of HDL-C and RC for identifying CKD stages and uremia. Conclusions: Alterations in HDL-C and RC were independently associated with renal function and uremic status. These findings suggest that lipoprotein composition may reflect metabolic disturbances accompanying CKD progression.
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