Association of Remnant Cholesterol Levels With Kidney Replacement Therapy Initiation in Korean Patients With Chronic Kidney Disease: A Prospective Cohort Study.

OBJECTIVE

Although remnant cholesterol (RC) is an established risk factor for atherosclerotic cardiovascular diseases, its role in chronic kidney disease (CKD) progression remains unclear. We aimed to investigate the association between RC levels and adverse kidney outcomes in patients with CKD.

METHODS

We analyzed data from the KoreaN Cohort Study for Outcomes in Patients With Chronic Kidney Disease, a prospective multicenter cohort study. Patients were categorized into quartiles according to their RC levels, calculated as total cholesterol level minus low-density lipoprotein cholesterol and high-density lipoprotein cholesterol levels. The primary outcome was the initiation of kidney replacement therapy (KRT).

RESULTS

Among 2,087 patients, 31% underwent KRT during a median follow-up of 8.0 years. Higher RC levels were significantly associated with an increased risk of KRT initiation. Compared with the lowest quartile (Q1), the adjusted hazard ratios (aHRs) for KRT initiation were 1.22 (95% confidence interval [CI], 0.95-1.57) for Q2, 1.32 (95% CI, 1.03-1.70) for Q3, and 1.42 (95% CI, 1.07-1.89) for Q4. A 1-standard deviation increase in RC level was associated with 16% higher risk of KRT initiation (aHR, 1.16; 95% CI, 1.05-1.29). This association remained significant, particularly among patients with diabetes and those with early-stage CKD.

CONCLUSION

Elevated RC levels were independently associated with a higher risk of KRT initiation in CKD patients. These findings suggest that RC is a risk factor for CKD progression and underscore the need for further studies to evaluate the potential benefits of RC-targeted lipid-modifying strategies for preserving kidney function.