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

Abstract Aims 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. Methods 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. Results 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). Conclusions At a country level, sustained achievement of ABC goals and most especially non-HDLc were associated with substantial reductions in iCKD.