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

ABSTRACT 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.