Association Between Serum High-Density Lipoprotein Cholesterol Levels and Progression of Chronic Kidney Disease: Results From the KNOW-CKD

Background: High-density lipoprotein cholesterol (HDL-C) levels are generally decreased in patients with chronic kidney disease (CKD). However, studies on the relationship between HDL-C and CKD progression are scarce. Methods and Results: We studied the association between serum HDL-C levels and the risk of CKD progression in 2168 participants of the KNOW-CKD (Korean Cohort Study for Outcome in Patients With Chronic Kidney Disease). The primary outcome was the composite of a 50% decline in estimated glomerular filtration rate from baseline or end-stage renal disease. The secondary outcome was the onset of end-stage renal disease. During a median follow-up of 3.1 (interquartile range, 1.6–4.5) years, the primary outcome occurred in 335 patients (15.5%). In a fully adjusted Cox model, the lowest category with HDL-C of <30 mg/dL (hazard ratio, 2.21; 95% CI, 1.30–3.77) and the highest category with HDL-C of ≥60 mg/dL (hazard ratio, 2.05; 95% CI, 1.35–3.10) were associated with a significantly higher risk of the composite renal outcome, compared with the reference category with HDL-C of 50 to 59 mg/dL. This association remained unaltered in a time-varying Cox analysis. In addition, a fully adjusted cubic spline model with HDL-C being treated as a continuous variable yielded similar results. Furthermore, consistent findings were obtained in a secondary outcome analysis for the development of end-stage renal disease. Conclusions: A U-shaped association was observed between serum HDL-C levels and adverse renal outcomes in this large cohort of patients with CKD. Our findings suggest that both low and high serum HDL-C levels may be detrimental to patients with nondialysis CKD.