Strong negative association of non-HDL cholesterol goal achievement with incident CKD among adults with diabetes


 
 
 We evaluated the effect of the achievement of HbA1c, systolic blood pressure (SBP) and LDL (LDLc) or non-HDL cholesterol (non-HDLc) goals (ABC goals) on the development of chronic kidney disease (iCKD) among patients with diabetes.
 
 
 
 In a nationwide registry of all individuals with diagnosed diabetes assisted by the health system in Colombia, we analyzed the association between baseline or sustained goal achievement and development of iCKD over a four-year follow-up. Incident CKD was defined as a new occurrence of an estimated glomerular filtration rate <60 mL/min/1.73m2, hemodialysis, peritoneal dialysis, or kidney transplant.
 
 
 
 The study included 998 790 adults with diabetes (56% female, mean age 59). There were 125 626 cases of incident CKD. After adjustment for multiple confounders, a baseline SBP < 130 mmHg (OR 0.79 [0.78-0.80]) and a baseline HbA1c < 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 <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 0.002).
 
 
 
 At a country level, sustained achievement of ABC goals and most especially non-HDLc were associated with substantial reductions in iCKD.
