Department of Endocrinology, Peking University People's Hospital, Beijing 100044, China.
Department of Endocrinology, Peking University People's Hospital, Beijing 100044, China.
J Diabetes Complications. 2023 Sep;37(9):108585. doi: 10.1016/j.jdiacomp.2023.108585. Epub 2023 Aug 17.
Studies on whether remnant cholesterol (RC) affects the progression of chronic kidney disease (CKD) remain insufficient. This study aimed to determine whether RC level was associated with the severity of CKD in patients with type 2 diabetes mellitus (T2DM).
In total, 3383 individuals diagnosed with T2DM were enrolled in this cross-sectional study from China. The severity of CKD was defined as no, moderate, severe, and very severe CKD based on the urinary albumin-to-creatinine ratio and estimated glomerular filtration rate. Because RC was non-normally distributed, it was log-transformed and categorized into quantiles. Multivariate logistic regression and multivariate ordinal logistic regression analysis were performed to investigate whether RC was independently associated with CKD and its severity.
The median RC level was 25.9 mg/dL. The number of patients with no, moderate, severe, and very severe CKD was 2587 (76.5 %), 520 (15.4 %), 189 (5.6 %), and 87 (2.5 %), respectively. After adjusting for confounding factors, the prevalence of CKD increased 1.67-fold when the log-transformed RC level was elevated by one unit (OR [95 % CI], 1.67 [1.43-1.95]). The likelihood of CKD severity increasing by one degree was 1.76-fold for each one-unit increase in log-transformed RC level (OR [95 % CI], 1.76 [1.52-2.05]). When RC was incorporated as a categorical variable, it still correlated with CKD severity compared with quantile 1 (Q1) (Q2, 1.30 [1.01-1.68]; Q3, 1.60 [1.23-2.07]; Q4, 2.39 [1.86-3.09]). The association remained regardless of whether the patient's traditional lipid profiles achieved the target range.
RC level was associated with CKD severity even when traditional lipid profiles were within the target range in patients with T2DM.
关于残余胆固醇（RC）是否会影响慢性肾脏病（CKD）的进展，相关研究仍不够充分。本研究旨在确定 RC 水平与 2 型糖尿病（T2DM）患者 CKD 严重程度之间的关系。
本横断面研究共纳入 3383 例中国 T2DM 患者。根据尿白蛋白与肌酐比值和估算肾小球滤过率，将 CKD 严重程度定义为无、中度、重度和极重度 CKD。由于 RC 呈非正态分布，因此对其进行了对数转换并进行了分位数分类。采用多变量逻辑回归和多变量有序逻辑回归分析来探讨 RC 是否与 CKD 及其严重程度独立相关。
RC 水平的中位数为 25.9mg/dL。无、中度、重度和极重度 CKD 的患者人数分别为 2587（76.5%）、520（15.4%）、189（5.6%）和 87（2.5%）。调整混杂因素后，当 RC 水平升高一个单位时，CKD 的患病率增加 1.67 倍（OR[95%CI]，1.67[1.43-1.95]）。RC 水平升高一个单位时，CKD 严重程度增加一个等级的可能性增加 1.76 倍（OR[95%CI]，1.76[1.52-2.05]）。当 RC 作为分类变量时，与 Q1（Q2，1.30[1.01-1.68]；Q3，1.60[1.23-2.07]；Q4，2.39[1.86-3.09]）相比，RC 仍与 CKD 严重程度相关。无论患者的传统血脂谱是否达到目标范围，这种关联都存在。
即使 T2DM 患者的传统血脂谱处于目标范围内，RC 水平仍与 CKD 严重程度相关。
