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Kidney Week

Abstract: TH-PO178

High High-Density Lipoprotein Cholesterol (HDL-C) Levels May Indicate a Higher Risk of ESRD and All-Cause Mortality in Patients with Type 2 Diabetes Mellitus (T2DM) and CKD

Session Information

Category: Diabetic Kidney Disease

  • 702 Diabetic Kidney Disease: Clinical

Author

  • Zou, Yutong, West China Hospital of Sichuan University, Chengdu, Sichuan, China
Background

To investigate the relationship between high-density lipoprotein cholesterol (HDL-C) and end-stage renal disease (ESRD) and all-cause mortality in patients with both diabetes mellitus (DM) and chronic kidney disease (CKD).

Methods

We enrolled 375 participants with confirmed diabetic kidney disease (DKD) via renal biopsy between January 2008 and September 2020 in our longitudinal observational study. Additionally, a total of 3,267 participants with DM and CKD from the National Health and Nutrition Examination Survey (NHANES) spanning 1999-2018 were included to examine the association between HDL-C concentration and all-cause mortality.

Results

Patients were divided into Group 1 (HDL-C<1.03mmol/L), Group 2 (1.55mmol/L>HDL-C≥1.03mmol/L), and Group 3 (HDL-C≥1.55mmol/L). Overall, of the 375 patients, after a median follow-up of 36 months, 165 participants (44%) developed ESRD. The Kaplan-Meier curves revealed a higher risk for ESRD among patients in Group 3 (p<0.001). After adjusting for potential confounders, patients in Group 3 were still found to have a significantly higher risk of ESRD compared to patients in Group 1, with an adjusted HR (95%CI) of 1.68(1.03, 2.71) (p=0.036). Higher levels of HDL3 and lower levels of HDL2 were associated with a higher risk for ESRD. Moreover, a total of 3,262 individuals with both DM and CKD in NHANES 1999-2018 were analyzed. After a median follow-up of 75 months, 1,369 participants (42%) had died. The weighted Kaplan-Meier curves reveal that higher HDL-C levels are associated with a higher risk of all-cause mortality (p=0.02). Notably, in patients with CKD stage 1-2, multivariate Cox regression analysis suggests that patients in Group 3 had a significantly higher HR of 1.61 (95%CI: 1.19, 2.19) (p=0.002).

Conclusion

This study identified a significant positive association of high concentration of HDL-C with incident ESRD and all-cause mortality in DKD patients. These findings may be different from previous beliefs about the role of HDL-C as “good cholesterol”.