Strong Negative Association of non-HDL Cholesterol Goal Achievement With Incident CKD Among Adults With Diabetes

Sofía Gnecco-González; Mateo Amaya-Montoya; Lina J Herrera-Parra; Juliana A Hernández Vargas; Nathaly Ramírez-García; Camila Romero-Díaz; Lizbeth Acuña-Merchán; Carlos O Mendivil

doi:10.1210/jendso/bvac193

Strong Negative Association of non-HDL Cholesterol Goal Achievement With Incident CKD Among Adults With Diabetes

J Endocr Soc. 2022 Dec 21;7(3):bvac193. doi: 10.1210/jendso/bvac193. eCollection 2023 Jan 6.

Authors

Sofía Gnecco-González¹, Mateo Amaya-Montoya¹, Lina J Herrera-Parra², Juliana A Hernández Vargas², Nathaly Ramírez-García², Camila Romero-Díaz¹, Lizbeth Acuña-Merchán², Carlos O Mendivil^{1

3}

Affiliations

¹ School of Medicine, Universidad de los Andes, Bogotá 110111, Colombia.
² Cuenta de Alto Costo, Fondo Colombiano de Enfermedades de Alto Costo, Bogotá 110111, Colombia.
³ Endocrinology Section, Department of Internal Medicine, Fundación Santa Fe de Bogotá, Bogotá 110111, Colombia.

Abstract

Context: The relative importance of the control of different metabolic risk factors for the prevention of chronic kidney disease among patients with diabetes in real life conditions is insufficiently understood.

Objective: We evaluated the effect of the achievement of glycated hemoglobin A_1c (HbA_1c), systolic blood pressure (SBP), and low-density lipoprotein cholesterol (LDLc) or non-high-density lipoprotein cholesterol (non-HDLc) goals (ABC goals) on the development of incident chronic kidney disease (iCKD) among patients with diabetes.

Methods: In a nationwide registry of all individuals diagnosed with diabetes assisted by the health system in Colombia, we analyzed the association between baseline or sustained goal achievement and development of iCKD over a 4-year follow-up. iCKD was defined as a new occurrence of an estimated glomerular filtration rate less than 60 mL/min/1.73 m², hemodialysis, peritoneal dialysis, or kidney transplant.

Results: The study included 998 790 adults with diabetes (56% female, mean age 59). There were 125 626 cases of iCKD. After adjustment for multiple confounders, a baseline SBP less than 130 mm Hg (odds ratio [OR] 0.79 [0.78-0.80]) and a baseline HbA_1c less than 7.0% (OR 0.86 [0.85-0.87]) were negatively associated with iCKD. Sustained achievement showed stronger negative associations with iCKD than just baseline achievement. Considering each goal separately, sustained non-HDLc less than 130 mg/dL had the strongest negative association with iCKD (OR 0.67 [0.65-0.69]). Patients who maintained the triple ABC goal over the entire follow-up had 32% (29-34) lower odds of developing CKD, 38% (34-42) if they additionally kept a normal body mass index (BMI). Sustained ABC control including a normal BMI was more strongly associated with a lower incidence of CKD in patients of Black race (OR 0.72 vs 0.89; P for interaction = .002).

Conclusion: At the country level, sustained achievement of ABC goals and most especially non-HDLc were associated with substantial reductions in iCKD.

Keywords: chronic kidney disease; diabetes; diabetes complications; hypertension; metabolic control; non-HDL cholesterol.