High Remnant Cholesterol is Associated with the Development of Diabetic Kidney Disease in Patients with Type 2 Diabetes.

Aim: The study aimed to explore the associations of the remnant cholesterol (RC) levels with the risk of diabetic kidney disease (DKD) in patients with type 2 diabetes mellitus (T2DM).

Methods: The study collected data from 23324 patients with T2DM from the UK Biobank (UKB) cohort and 3059 patients with T2DM from the Chongqing Diabetes Registry (CDR) cohort. UKB and CDR cohort were followed for incident DKD until October 2020 and March 2023, respectively. Cox proportional hazards regression was performed to explore the relationship between RC levels and incident DKD.

Results: Participants from the UKB and CDR were followed for a mean period of 13.72 years and 1.92 years, respectively. The incidences of DKD are 12.9% and 24.5%. Participants were divided into 4 groups: 0.41 mmol/L or less, 0.41 to 0.56 mmol/L, 0.56 to 0.73 mmol/L, and greater than 0.73 mmol/L according to RC levels. Lower RC levels (≤0.41 mmol/L) were used as a reference, multi-adjusted model showing that patients with higher RC levels (>0.73 mmol/L) in the UKB were associated with increased risk of incident DKD [hazard ratio [HR], 1.27; 95% CI, 1.10-1.46; P = 0.001]. These results were consistent in the CDR [HR (95% CI): 1.39 (1.03, 1.89); P = 0.034]. In the stratified analyses, we observed an increase in the risk of incident DKD with RC in the elderly patients, while not in the middle-aged patients in both UKB cohort [HR (95% CI): 1.33 (1.13, 1.57) vs 1.16 (0.89, 1.50), P for interaction = 0.043] and CDR cohort [HR (95% CI): 1.53 (1.02, 2.30) vs 1.23 (0.76, 2.00), P for interaction = 0.009].

Conclusion: High RC might be an independent risk factor for new-onset DKD in T2DM population after adjusting for traditional risk factors, especially in elderly T2DM patients.