High density lipoprotein cholesterol levels are an independent predictor of the progression of chronic kidney disease

J Intern Med. 2013 Sep;274(3):252-62. doi: 10.1111/joim.12081. Epub 2013 May 11.


Objectives: Patients with chronic kidney disease (CKD) often present with reduced plasma HDL cholesterol (HDL-C) levels. Whether this reduction in an epiphenomenon or is involved in disease progression is unclear. The aim of this study was to investigate the relation between HDL-C levels/function and CKD progression in patients with different degrees of disease.

Design: A total of 176 patients with CKD [glomerular filtration rate (GFR) 50.3 ± 29.1 mL min⁻¹] were recruited and followed for up to 84 months. Lipid profile, metabolic status and kidney function were evaluated at predetermined times. Age-matched control subjects were selected from the PLIC study (n = 453). Scavenger receptor class B member 1 (SR-BI) and ATP-binding cassette transporter A1 (ABCA-1)-dependent efflux of cholesterol were measured in CKD patients and in age-matched control subjects.

Results: Low HDL-C levels, diabetes and hypertension were associated with reduced GFR. At follow-up, low HDL-C levels were associated with earlier entry in dialysis or doubling of the plasma creatinine level (P = 0.017); HDL-C levels were the only lipid parameter that affected the progression of CKD (hazard ratio 0.951, 95% confidence interval 0.917-0.986, P = 0.007), independently of the presence of diabetes. Only SR-BI-mediated serum cholesterol efflux was significantly reduced in the group of CKD patients with low HDL-C levels compared to the control group.

Conclusions: CKD patients with low levels of plasma HDL-C have a poor prognosis. HDL functionality is also impaired in renal dysfunction. These data support the relevance of HDL in influencing CKD progression.

Keywords: ABCA-1; HDL; SR-BI; cholesterol efflux; chronic kidney disease; dialysis.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • ATP-Binding Cassette Transporters / blood
  • Aged
  • Case-Control Studies
  • Cholesterol, HDL / blood*
  • Creatinine / blood
  • Disease Progression
  • Female
  • Humans
  • Kidney Function Tests
  • Male
  • Predictive Value of Tests
  • Prognosis
  • Prospective Studies
  • ROC Curve
  • Regression Analysis
  • Renal Insufficiency, Chronic / blood*
  • Renal Insufficiency, Chronic / physiopathology*
  • Risk Factors
  • Scavenger Receptors, Class B / blood


  • ATP-Binding Cassette Transporters
  • Cholesterol, HDL
  • Scavenger Receptors, Class B
  • Creatinine