Lipid parameters and the risk of incident CKD: an analysis of conventional and composite lipid indices

Abstract

Dyslipidemia is predominant in chronic kidney disease (CKD) patients and is usually characterized by high levels of triglyceride (TG), decreased high-density lipoprotein cholesterol (HDL-C), and normal or slightly elevated low-density lipoprotein cholesterol (LDL-C). Nevertheless, the link between this distinct dyslipidemic profile and the risk of incident CKD is not yet fully understood. This 6-year retrospective cohort study recruited adults aged ≥ 40 years with baseline eGFR > 60 mL/min/1.73 m². The lipid parameters measured were TG, total cholesterol (TC), HDL-C, LDL-C, TG/HDL-C ratio (TG/HDL-C), TC/HDL-C ratio (TC/HDL-C), non-HDL-C/HDL-C ratio (NHHR), and residual cholesterol (RC). The main outcome was incident CKD, defined as a ≥ 30% decline in eGFR from baseline accompanied by a final eGFR < 60 mL/min/1.73 m² at the end of follow-up. Multivariate logistic regression, restricted cubic spline and subgroup analyses were applied to evaluate the relationships between lipid parameters and incident CKD, with the potential confounders, such as demographic factors and clinical covariates, being adjusted. A total of 3,856 participants were included, among whom 453 (11.7%) developed incident CKD. After full adjustment, participants in the highest log 10 -transformed TGs (log-TG) tertile had 59% higher odds of incident CKD versus the lowest tertile (OR = 1.59, 95% CI: 1.24–2.05), TC (OR = 1.49, 95% CI: 1.15–1.92), the TC/HDL-C ratio (OR = 1.51, 95% CI: 1.17–1.95), the TG/HDL-C ratio (OR = 1.63, 95% CI: 1.26–2.10), the NHHR (OR = 1.51, 95% CI: 1.17–1.95), and RC (OR = 1.50, 95% CI: 1.18–1.92). On the other hand, an increase in HDL-C levels was linked to a lower risk of incident CKD (OR = 0.75, 95% CI: 0.58–0.96). These associations were mostly similar in prespecified subgroups; in particular, the TG/HDL-C ratio showed a higher effect estimate in people without diabetes. TG, TC, the TC/HDL-C ratio, the TG/HDL-C ratio, the NHHR, and RC were all positively associated with incident CKD, whereas HDL-C was negatively associated. Not applicable.