Risk of end-stage renal disease in Korean patients with type 2 diabetes according to cumulative low-density lipoprotein cholesterol levels

초록

Objective: Lifelong cumulative high low-density lipoprotein cholesterol (LDL-C) levels are associated with atherosclerosis burden. This study analyzed the association between cumulative LDL-C levels and the risk of end-stage renal disease (ESRD) in Korean adults with type 2 diabetes (T2D). Research Design and Methods: The incidence of ESRD was analyzed in Korean type 2 diabetes patients aged >20 years who underwent national health examinations from 2015 to 2016. Cumulative LDL-C levels were categorized based on the number of times the levels were >= 130 mg/dL during the examinations. The risk of ESRD across groups was analyzed using the Kaplan-Meier method and Cox proportional hazards model. Results: Among 318,645 patients, the number of occurrences of cumulative LDL >= 130 mg/dL were 0 (154,535), 1 (63,521), 2 (42,563), 3 (32,423), and >= 4 (25,594). Using a multivariable model with adjustment for multiple confounding variables, the risk of ESRD increased with the number of high cumulative LDL-C: hazard ratio (HR) 1.33 (95% confidence interval [CI] 1.17-1.50), 1.51 (1.29-1.76), 1.99 (1.29-1.76), and 2.05 (1.66-2.54) for 1 to >= 4 occurrences, respectively. In patients taking three oral antidiabetic medications, the HR of ESRD was 1.51 (1.23-1.84), 2.10 (1.66-2.66), 3.07 (2.34-4.03), and 3.11 (2.05-2.72) for 1 to >= 4 occurrences compared with 0, respectively. For patients with diabetes duration >= 10 years, the HR of ESRD was 1.45 (1.24-1.70), 1.93 (1.59-2.35), 2.47 (1.94-3.15), and 2.97 (2.18-4.03) for 1 to >= 4 occurrences, respectively. Conclusions: ESRD risk increased with high cumulative LDL-C levels. This difference was more pronounced in patients with diabetes taking multiple antidiabetic medications and in those with a longer duration of diabetes.

키워드