Jun Hwa Hong

doi:10.4093/dmj.2025.0929

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Letter Impact of Remnant Cholesterol on the Risk for End-Stage Renal Disease in Type 2 Diabetes Mellitus: A Nationwide Population-Based Cohort Study (Diabetes Metab J 2025;49:1106-15): Jun Hwa Hong; Diabetes & Metabolism Journal 2026;50(1):190-191.
DOI: https://doi.org/10.4093/dmj.2025.0929
Published online: January 1, 2026

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Division of Endocrinology, Department of Internal Medicine, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, Korea

Corresponding author: Jun Hwa Hong

Division of Endocrinology, Department of Internal Medicine, Daejeon Eulji Medical Center, Eulji University School of Medicine, 95 Dunsanseo-ro, Seo-gu, Daejeon 35233, Korea E-mail: lammoth@naver.com

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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See the reply "Impact of Remnant Cholesterol on the Risk for End-Stage Renal Disease in Type 2 Diabetes Mellitus: A Nationwide Population-Based Cohort Study (Diabetes Metab J 2025;49:1106-15)" in Volume 50 on page 203.

See the article "Impact of Remnant Cholesterol on the Risk for End-Stage Renal Disease in Type 2 Diabetes Mellitus: A Nationwide Population-Based Cohort Study" on page 1106.

End-stage kidney disease (ESKD) is an established complication of diabetes; even in prediabetes, progression of ESKD can occur. In a nationwide epidemiologic study in South Korea, newly diagnosed ESKD was observed in patients with early-phase (impaired fasting glucose) and short-duration (5 years) diabetes [1]. Remnant cholesterol is associated with insulin resistance and related to new-onset diabetes as well as the development of atherosclerotic cardiovascular disease (ASCVD), stroke, and dementia [2–5]. Furthermore, remnant cholesterol is also a risk factor for the progression of ESKD in type 2 diabetes mellitus (T2DM). During a median follow-up period of 10.3 years, 26,246 patients with T2DM (1.03%) developed ESKD. Participants in the highest quartile for remnant cholesterol had a higher risk of ESKD, with hazard ratios (HRs) of 1.33 (95% confidence interval [CI], 1.26 to 1.41) [2].

Huh et al. [2] reported previously that high remnant-cholesterol levels increase the risk for end-stage renal disease (ESRD) in a nationwide, population-based, cohort study based on National Health Insurance Service health examination (n=3,856,985) data; participants were followed until the onset of ESKD. The median duration of follow-up was 10.3 years, 13.5% of the highest quartile group consisted of patients with diabetes. ESKD developed in 11,073 (0.29%) participants. The risk of ESKD exhibited a greater increase according to higher levels of remnant cholesterol, with a 61% higher increase in risk in the highest quartile than in the lowest (HR, 1.61; 95% CI, 1.50 to 1.72) [6]. The HR of remnant cholesterol to ESKD was variable across the two studies (HR, 1.33 vs. 1.61).

Low-density lipoprotein (LDL) cholesterol is also associated with progression of cardiovascular and renal outcomes in patients with moderate chronic kidney disease. Target LDL levels depend on accompanying comorbidities. LDL cholesterol is a risk factor for ASCVD in the general population; thus, its direct link to the incidence of ESRD is complex and not as clear-cut in patients with established kidney disease, partly due to confounding factors like malnutrition and inflammation. Additionally, because remnant cholesterol is calculated as (total cholesterol–HDL cholesterol–LDL cholesterol), LDL cholesterol itself may affect remnant cholesterol.

Thus, the causal relationship of remnant cholesterol with progression to ESKD need to be analyzed by stratum of LDL (<70 mg/dL, 70< LDL <100 mg/dL, >130 mg/dL). Further large-scale prospective studies are needed to explore the causal relationship of remnant cholesterol and management strategies. More detailed analysis of remnant cholesterol that takes LDL cholesterol level into account may inform future development of individualized ESKD prevention strategies.

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CONFLICTS OF INTEREST

No potential conflict of interest relevant to this article was reported.

REFERENCES

1. Roh E, Heo JH, Jung HN, Han KD, Kang JG, Lee SJ, et al. Impact of remnant cholesterol on the risk for end-stage renal disease in type 2 diabetes mellitus: a nationwide population-based cohort study. Diabetes Metab J 2025;49:1106-15.Article PubMed PMC
2. Huh JH, Roh E, Lee SJ, Ihm SH, Han KD, Kang JG. Remnant cholesterol is an independent predictor of type 2 diabetes: a nationwide population-based cohort study. Diabetes Care 2023;46:305-12.PubMed
3. Yang XH, Zhang BL, Cheng Y, Fu SK, Jin HM. Association of remnant cholesterol with risk of cardiovascular disease events, stroke, and mortality: a systemic review and meta-analysis. Atherosclerosis 2023;371:21-31.Article PubMed
4. Wang D, Zhang Z, Zhang Y, Chen S, Qu N, Li H, et al. Two-year changes in remnant cholesterol and stroke risk in the chinese population: a prospective cohort study. J Am Heart Assoc 2025;14:e038559.Article PubMed PMC
5. Heo JH, Jung HN, Roh E, Han KD, Kang JG, Lee SJ, et al. Association of remnant cholesterol with risk of dementia: a nationwide population-based cohort study in South Korea. Lancet Healthy Longev 2024;5:e524-33.Article PubMed
6. Jung HN, Huh JH, Roh E, Han KD, Kang JG, Lee SJ, et al. High remnant-cholesterol levels increase the risk for end-stage renal disease: a nationwide, population-based, cohort study. Lipids Health Dis 2024;23:165.Article PubMed PMC PDF

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Impact of Remnant Cholesterol on the Risk for End-Stage Renal Disease in Type 2 Diabetes Mellitus: A Nationwide Population-Based Cohort Study (Diabetes Metab J 2025;49:1106-15)

Diabetes Metab J. 2026;50(1):190-191. Published online January 1, 2026

DOI: https://doi.org/10.4093/dmj.2025.0929

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Impact of Remnant Cholesterol on the Risk for End-Stage Renal Disease in Type 2 Diabetes Mellitus: A Nationwide Population-Based Cohort Study (Diabetes Metab J 2025;49:1106-15)

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Hong JH. Impact of Remnant Cholesterol on the Risk for End-Stage Renal Disease in Type 2 Diabetes Mellitus: A Nationwide Population-Based Cohort Study (Diabetes Metab J 2025;49:1106-15). Diabetes Metab J. 2026;50(1):190-191.

DOI: https://doi.org/10.4093/dmj.2025.0929.

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