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Associations between remnant cholesterol and cardiovascular events in patients undergoing dialysis: a nationwide

Byung Sik Kim1, Hyun-Jin Kim1, Jiyeong Kim2,3

  • 1Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Republic of Korea.

Kidney Research and Clinical Practice
|May 11, 2026
PubMed

Insights

High remnant cholesterol increases myocardial infarction risk in dialysis patients, independent of LDL-C. This finding highlights remnant cholesterol as a key factor for cardiovascular risk in this high-risk group.

Area of Science:

  • Cardiology
  • Nephrology
  • Biochemistry

Background:

  • Remnant cholesterol is a known cardiovascular disease risk factor.
  • Its role in dialysis patients, a high-risk group, is unclear.
  • This study investigates remnant cholesterol's prognostic value in end-stage kidney disease patients.

Purpose of the Study:

  • To evaluate the association between remnant cholesterol levels and cardiovascular outcomes.
  • To determine if remnant cholesterol is an independent risk factor for myocardial infarction and ischemic stroke in dialysis patients.

Main Methods:

  • Retrospective cohort study of 21,679 end-stage kidney disease patients on dialysis.
  • Data from the Korean National Health Insurance Service database (2009-2017).
  • Patients stratified by baseline remnant cholesterol quartiles; primary outcomes were myocardial infarction and ischemic stroke.

Main Results:

  • Elevated remnant cholesterol (Quartile 4 vs. 1) was associated with a 26% increased risk of myocardial infarction (HR 1.26).
  • A steady increase in myocardial infarction risk was observed with rising remnant cholesterol levels.
  • No significant association was found between remnant cholesterol and ischemic stroke risk.

Conclusions:

  • Elevated remnant cholesterol is independently associated with higher myocardial infarction risk in dialysis patients.
  • Remnant cholesterol may contribute to residual cardiovascular risk, independent of LDL-C.
  • These findings emphasize the importance of monitoring remnant cholesterol in patients with end-stage kidney disease.
Abstract

Keywords:
CholesterolChronic kidney failureDialysisHeart disease risk factorsLipids

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