Association of remnant cholesterol with kidney outcomes in adults with type 2 diabetes: a systematic review and meta-analysis
4 affiliations
- 1The First Clinical Medical College, Yan'an Medical College, Yan'an University
- 2Yan'an Medical College, Yan'an University
- 3Department of Endocrinology, Affiliated Hospital of Yan'an University
- 4Department of Nephrology, The Second Affiliated Hospital of Xi’an Jiaotong University
Abstract
Introduction: Remnant cholesterol (RC) reflects the cholesterol carried by triglyceride-rich lipoprotein remnants and may capture lipid-related kidney risk not fully represented by conventional lipid measures. We evaluated the associations between RC and kidney outcomes in adults with type 2 diabetes mellitus (T2DM).
Methods: Following PRISMA 2020, PubMed/MEDLINE, Scopus, the Cochrane Library, Google Scholar, Wiley Online Library, and ScienceDirect were searched for longitudinal and cross-sectional observational studies evaluating circulating RC and kidney outcomes in adults with T2DM. Studies of mixed populations were eligible only when T2DM-specific data could be extracted. Adjusted effect estimates were pooled separately by study design and kidney outcome using restricted maximum likelihood random-effects models with Hartung–Knapp adjustment.
Results: Seventeen articles contributed 18 independent estimates from 2,817,820 participants with T2DM. The exploratory all-study model showed an association between higher RC and adverse kidney outcomes (association ratio 1.50, 95% CI 1.32–1.72, P < 0.001; I ² = 87.6%). The longitudinal model, comprising 12 independent estimates from 11 articles, showed a similar association (HR 1.27, 95% CI 1.17–1.37, P < 0.001; I ² = 42.9%). Outcome-specific analyses showed an association with incident diabetic kidney disease (DKD; HR 1.27, 95% CI 1.15–1.41, P = 0.0029). The estimate for kidney failure/end-stage kidney disease was positive but not statistically significant (HR 1.56, 95% CI 0.82–2.97, P = 0.115). The association with DKD progression also did not reach statistical significance (HR 1.17, 95% CI 1.00–1.37, P = 0.052), while one study reported an association with incident albuminuria (HR 1.23, 95% CI 1.06–1.43, P = 0.007). Six cross-sectional studies showed an association between higher RC and prevalent or early DKD in adults with T2DM (OR 2.03, 95% CI 1.71–2.42, P < 0.001; I ² = 2.5%). The longitudinal association remained after restricting the analysis to estimates adjusted for blood pressure, glycemia, and adiposity (HR 1.28, 95% CI 1.21–1.37, P < 0.001). A smaller subset that included continuous estimates showed that a 0.1 mmol/L increase in RC was not associated with incident DKD (HR 1.02, 95% CI 0.98–1.07, P = 0.197).
Conclusions: Higher RC was associated with incident and prevalent DKD and with adverse longitudinal kidney outcomes overall in adults with T2DM. RC may serve as a complementary kidney-risk marker, but the observational evidence does not establish causality or a clinical threshold.
Systematic review registration : https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD420261475085 , identifier CRD420261475085.
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BibTeX
@article{gao2026association,
title = {{Association of remnant cholesterol with kidney outcomes in adults with type 2 diabetes: a systematic review and meta-analysis}},
author = {Jie Gao and Jiaqi Wang and Zhangli Wang},
journal = {Frontiers in Endocrinology},
year = {2026},
month = oct,
doi = {10.3389/fendo.2026.1969361},
url = {https://www.frontiersin.org/articles/10.3389/fendo.2026.1969361/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Association of remnant cholesterol with kidney outcomes in adults with type 2 diabetes: a systematic review and meta-analysis
AU - Jie Gao
AU - Jiaqi Wang
AU - Zhangli Wang
PY - 2026
DA - 2026/10/16
JO - Frontiers in Endocrinology
DO - 10.3389/fendo.2026.1969361
UR - https://www.frontiersin.org/articles/10.3389/fendo.2026.1969361/full
AB - Introduction: Remnant cholesterol (RC) reflects the cholesterol carried by triglyceride-rich lipoprotein remnants and may capture lipid-related kidney risk not fully represented by conventional lipid measures. We evaluated the associations between RC and kidney outcomes in adults with type 2 diabetes mellitus (T2DM). Methods: Following PRISMA 2020, PubMed/MEDLINE, Scopus, the Cochrane Library, Google Scholar, Wiley Online Library, and ScienceDirect were searched for longitudinal and cross-sectional observational studies evaluating circulating RC and kidney outcomes in adults with T2DM. Studies of mixed populations were eligible only when T2DM-specific data could be extracted. Adjusted effect estimates were pooled separately by study design and kidney outcome using restricted maximum likelihood random-effects models with Hartung–Knapp adjustment. Results: Seventeen articles contributed 18 independent estimates from 2,817,820 participants with T2DM. The exploratory all-study model showed an association between higher RC and adverse kidney outcomes (association ratio 1.50, 95% CI 1.32–1.72, P < 0.001; I ² = 87.6%). The longitudinal model, comprising 12 independent estimates from 11 articles, showed a similar association (HR 1.27, 95% CI 1.17–1.37, P < 0.001; I ² = 42.9%). Outcome-specific analyses showed an association with incident diabetic kidney disease (DKD; HR 1.27, 95% CI 1.15–1.41, P = 0.0029). The estimate for kidney failure/end-stage kidney disease was positive but not statistically significant (HR 1.56, 95% CI 0.82–2.97, P = 0.115). The association with DKD progression also did not reach statistical significance (HR 1.17, 95% CI 1.00–1.37, P = 0.052), while one study reported an association with incident albuminuria (HR 1.23, 95% CI 1.06–1.43, P = 0.007). Six cross-sectional studies showed an association between higher RC and prevalent or early DKD in adults with T2DM (OR 2.03, 95% CI 1.71–2.42, P < 0.001; I ² = 2.5%). The longitudinal association remained after restricting the analysis to estimates adjusted for blood pressure, glycemia, and adiposity (HR 1.28, 95% CI 1.21–1.37, P < 0.001). A smaller subset that included continuous estimates showed that a 0.1 mmol/L increase in RC was not associated with incident DKD (HR 1.02, 95% CI 0.98–1.07, P = 0.197). Conclusions: Higher RC was associated with incident and prevalent DKD and with adverse longitudinal kidney outcomes overall in adults with T2DM. RC may serve as a complementary kidney-risk marker, but the observational evidence does not establish causality or a clinical threshold. Systematic review registration : https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD420261475085 , identifier CRD420261475085.
SN - 1664-2392
ER -