High remnant-cholesterol levels increase the risk for end-stage renal disease: a nationwide, population-based, cohort study

Abstract Background The effect of remnant-cholesterol (remnant-C) on incident end-stage renal disease (ESRD) has not been studied longitudinally. This retrospective cohort study evaluated the association between remnant-C and the development of ESRD in a nationwide Korean cohort. Methods Participants in a National Health Insurance Service health examination ( n = 3,856,985) were followed up until the onset of ESRD. The median duration of follow-up was 10.3 years. The Martin-Hopkins equation was used to determine low-density lipoprotein cholesterol (LDL-C) levels from directly measured triglyceride, high-density lipoprotein cholesterol (HDL-C), and total cholesterol levels. Remnant-C levels were determined by subtracting HDL-C and LDL-C from total cholesterol. The risk for incident ESRD was calculated for each quartile of remnant-C, adjusting for conventional risk factors such as baseline renal function, comorbidities, and total cholesterol levels. Results ESRD developed in 11,073 (0.29%) participants. The risk for ESRD exhibited a gradual increase according to higher levels of remnant-C, with a 61% increased risk in the highest quartile than in the lowest (hazard ratio HR 1.61 95% confidence interval (CI) 1.50–1.72). The elevated risk for ESRD in the highest quartile versus the lowest quartile was more prominent in younger than in older subjects (20–29 years, HR 4.07 95% CI 2.85–5.83; 30–39 years, HR 2.39 95% CI 1.83–3.13; ≥ 70 years, HR 1.32 95% CI 1.16–1.51). In addition, the increased risk for ESRD related to higher remnant-C levels was greater in females than in males. Conclusions Independent of conventional risk factors, remnant-C levels were positively associated with incident ESRD, particularly in younger populations and adult females. Reducing remnant-C levels may be a novel preventive strategy against ESRD.