Association between remnant cholesterol and chronic kidney disease: Systematic review and meta-analysis

IF 5.7 2区医学 Q1 ENDOCRINOLOGY & METABOLISM Diabetes, Obesity & Metabolism Pub Date : 2025-02-14 DOI:10.1111/dom.16258

Paschalis Karakasis MD, Dimitrios Patoulias PhD, Manfredi Rizzo PhD, Nikolaos Fragakis PhD, Christos S. Mantzoros PhD

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Abstract

Background and Aims

Adequate lipid control has emerged as a key factor in the prevention and management of chronic kidney disease (CKD). Remnant cholesterol (RC), a lipoprotein with an established association with cardiovascular risk, has been investigated in the context of CKD. Given the conflicting results from recent studies, we performed this meta-analysis to summarize the existing evidence on the association between RC and CKD.

Methods

Medline, Cochrane Library and Scopus were searched until 16 September 2024. Double-independent study selection, data extraction and quality assessment were performed. Evidence was pooled using random-effects meta-analyses. We set as primary end-point of interest the association between RC and CKD.

Results

Twelve studies (4 139 674 participants) were included. Participants with RC values in the highest quantile had significantly greater odds of CKD compared to those in the lowest quantile (Odds Ratio [OR] = 1.46, 95% confidence interval [CI] = 1.26–1.68). In a sensitivity analysis confined to subjects with type 2 diabetes (T2D), those in the higher RC quantile also exhibited significantly increased odds of CKD compared to those in the lowest quantile (OR = 1.46, 95% CI = 1.20–1.78). A significant inverse association was observed between RC and estimated glomerular filtration rate (Mean Difference [MD] = −1.43 mL/min/1.73 m² for each 1 mmol/L increase in RC, 95% CI = [−2.67, −0.19]). Additionally, individuals with T2D-related CKD had a 24% increased risk of progression to end-stage renal disease for each 1 standard deviation increase in RC (Hazard Ratio [HR] = 1.24, 95% CI = 1.04–1.47).

Conclusions

RC is directly associated with higher risk for CKD. Beyond traditional lipid markers, greater emphasis should be placed on RC levels in individuals with or at risk for CKD.

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残余胆固醇与慢性肾脏疾病的关系：系统回顾和荟萃分析。

背景和目的：适当的脂质控制已成为预防和管理慢性肾脏疾病（CKD）的关键因素。残余胆固醇（RC）是一种与心血管风险相关的脂蛋白，已经在CKD的背景下进行了研究。鉴于最近的研究结果相互矛盾，我们进行了这项荟萃分析，以总结关于RC和CKD之间关联的现有证据。方法：检索Medline、Cochrane Library和Scopus，截止到2024年9月16日。进行双独立研究选择、数据提取和质量评价。使用随机效应荟萃分析汇集证据。我们将RC和CKD之间的关系作为主要研究终点。结果：纳入12项研究（4 139 674名受试者）。RC值在最高分位数的参与者与最低分位数的参与者相比，患CKD的几率显著增加（比值比[OR] = 1.46, 95%可信区间[CI] = 1.26-1.68）。在一项局限于2型糖尿病（T2D）患者的敏感性分析中，与最低分位数的患者相比，较高RC分位数的患者CKD的发生率也显著增加（OR = 1.46, 95% CI = 1.20-1.78）。RC与肾小球滤过率呈显著负相关（RC每增加1 mmol/L，平均差[MD] = -1.43 mL/min/1.73 m2, 95% CI =[-2.67, -0.19]）。此外，t2d相关CKD患者RC每增加1个标准差，进展为终末期肾病的风险增加24%（危险比[HR] = 1.24, 95% CI = 1.04-1.47）。结论：RC与CKD的高风险直接相关。除了传统的脂质标志物外，对于患有或有CKD风险的个体，RC水平应该得到更大的重视。

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来源期刊

Diabetes, Obesity & Metabolism 医学-内分泌学与代谢

CiteScore

10.90

自引率

6.90%

发文量

319

审稿时长

3-8 weeks

期刊介绍： Diabetes, Obesity and Metabolism is primarily a journal of clinical and experimental pharmacology and therapeutics covering the interrelated areas of diabetes, obesity and metabolism. The journal prioritises high-quality original research that reports on the effects of new or existing therapies, including dietary, exercise and lifestyle (non-pharmacological) interventions, in any aspect of metabolic and endocrine disease, either in humans or animal and cellular systems. ‘Metabolism’ may relate to lipids, bone and drug metabolism, or broader aspects of endocrine dysfunction. Preclinical pharmacology, pharmacokinetic studies, meta-analyses and those addressing drug safety and tolerability are also highly suitable for publication in this journal. Original research may be published as a main paper or as a research letter.