Department of Endocrinology, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, Sichuan, China.
Department of General Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, Sichuan, China.
Acta Diabetol. 2021 Dec;58(12):1615-1625. doi: 10.1007/s00592-021-01765-z. Epub 2021 Jun 28.
Limited data regarding the association between remnant cholesterol (RC) and chronic kidney disease (CKD), largely based on an estimated glomerular filtration rate (eGFR) of < 60 mL/min/1.73 m (low eGFR), have yielded inconsistent results, and no report has demonstrated the relationship of RC with CKD [defined as low eGFR and/or albuminuria (defined as urinary albumin-to-creatinine ratio (ACR) ≥ 30 mg/g)] in Chinese general middle-aged and elderly population. Hence, we aimed to investigate the association between RC and CKD in such population.
In total, 7356 Chinese participants aged ≥ 40 years were recruited from five regional communities in Luzhou city between May 2011 and December 2011. Fasting RC was calculated from the lipid profile measured by standard laboratory procedures. Multivariate logistic regression models were used to evaluate the possible association between RC and CKD.
Participants in the highest quartile of RC had higher body mass index, systolic and diastolic blood pressure, total cholesterol, triglyceride, low-density lipoprotein cholesterol (LDL-C), fasting and 2-h postload blood glucose, glycated hemoglobin A1C, prevalence of prediabetes, type 2 diabetes mellitus (T2DM), hypertension, CKD, albuminuria, low eGFR, and lower high-density lipoprotein cholesterol (HDL-C) and eGFR compared with those in the lowest quartile (all P for trend < 0.01). Multivariate logistic regression analysis demonstrated that the risk of CKD gradually increased across RC quartiles (P for trend < 0.01), and participants in the highest quartile of RC were at a significantly increased risk of prevalent CKD compared to those in the lowest quartile in total subjects (odds rate: 1.344, 95% confidence intervals 1.097-1.648, P < 0.01). In subgroup analysis, significant relation between RC level and increased risk of prevalent CKD was detected in women, subjects with overweight/obesity, non-prediabetes, hypertension, normal HDL-C, appropriate and high LDL-C, and without cardiovascular disease (CVD) events after multiple adjustments.
Higher RC is independently associated with increased risk of prevalent CKD, and RC might serve as a new risk biomarker for CKD in a general middle-aged and elderly Chinese population, especially in women, subjects with overweight/obesity, non-prediabetes, hypertension, normal HDL-C, appropriate and high LDL-C, and without CVD events.
基于肾小球滤过率（eGFR）<60ml/min/1.73m（低 eGFR）的估计值，有关残余胆固醇（RC）与慢性肾脏病（CKD）之间关联的研究数据有限，且结果不一致，尚无报告表明 RC 与 CKD [定义为低 eGFR 和/或白蛋白尿（定义为尿白蛋白与肌酐比值（ACR）≥30mg/g）]之间存在关联。因此，我们旨在研究中国一般中老年人群中 RC 与 CKD 之间的关系。
2011 年 5 月至 2011 年 12 月，从泸州市五个区域社区招募了 7356 名年龄≥40 岁的中国参与者。空腹 RC 是通过标准实验室程序测量的血脂谱计算得出的。采用多变量逻辑回归模型评估 RC 与 CKD 之间可能存在的关联。
RC 最高四分位组的参与者体重指数、收缩压和舒张压、总胆固醇、甘油三酯、低密度脂蛋白胆固醇（LDL-C）、空腹和 2 小时餐后血糖、糖化血红蛋白 A1C、糖尿病前期、2 型糖尿病（T2DM）、高血压、CKD、白蛋白尿、低 eGFR 患病率更高，而高密度脂蛋白胆固醇（HDL-C）和 eGFR 水平更低（所有趋势 P<0.01）。多变量逻辑回归分析表明，随着 RC 四分位数的增加，CKD 的风险逐渐增加（趋势 P<0.01），与最低四分位组相比，RC 最高四分位组的患者发生 CKD 的风险显著增加（优势比：1.344，95%置信区间 1.097-1.648，P<0.01）。在亚组分析中，在女性、超重/肥胖、非糖尿病前期、高血压、正常 HDL-C、适当和高 LDL-C、无心血管疾病（CVD）事件的患者中，RC 水平与 CKD 风险增加之间存在显著关系，经多次调整后。
较高的 RC 与 CKD 发病风险增加独立相关，RC 可能是中国一般中老年人群 CKD 的新风险生物标志物，特别是在女性、超重/肥胖、非糖尿病前期、高血压、正常 HDL-C、适当和高 LDL-C、无 CVD 事件的患者中。
